Healthcare Provider Details

I. General information

NPI: 1518955368
Provider Name (Legal Business Name): RONALD J WILL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 06/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14017 N NEWPORT HWY STE E
MEAD WA
99021-9203
US

IV. Provider business mailing address

14017 N NEWPORT HWY STE E
MEAD WA
99021-9203
US

V. Phone/Fax

Practice location:
  • Phone: 509-465-2252
  • Fax:
Mailing address:
  • Phone: 509-465-2252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9215
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: