Healthcare Provider Details

I. General information

NPI: 1528065901
Provider Name (Legal Business Name): RONALD DAVID VENEZIE DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 08/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 W WILLIAMS ST
APEX NC
27502-1846
US

IV. Provider business mailing address

504 W WILLIAMS ST
APEX NC
27502-1846
US

V. Phone/Fax

Practice location:
  • Phone: 919-303-2873
  • Fax:
Mailing address:
  • Phone: 919-303-2873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number5964
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: