Healthcare Provider Details

I. General information

NPI: 1801839329
Provider Name (Legal Business Name): RONALD ORIN MAXFIELD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4476 W VAN GIESEN ST
WEST RICHLAND WA
99353-5411
US

IV. Provider business mailing address

4476 W VAN GIESEN ST
WEST RICHLAND WA
99353-5411
US

V. Phone/Fax

Practice location:
  • Phone: 509-967-3421
  • Fax: 509-967-2186
Mailing address:
  • Phone: 509-967-3421
  • Fax: 509-967-2186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6057
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: