Healthcare Provider Details

I. General information

NPI: 1700072410
Provider Name (Legal Business Name): RONALD J SAXEN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 09/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 WALES AVE NW STE E
MASSILLON OH
44646-2367
US

IV. Provider business mailing address

2400 WALES AVE NW STE E
MASSILLON OH
44646-2367
US

V. Phone/Fax

Practice location:
  • Phone: 330-832-7434
  • Fax: 330-832-2828
Mailing address:
  • Phone: 330-832-7434
  • Fax: 330-832-2828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14859
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: