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General NPI Number Information
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NPI Number | 1093785362
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Entity Type | Individual
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Provider Name | RONALD W. ENG D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 01/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | VANCHCS OUTPATIENT CLINIC. DENTAL SERVICE (160/MI) BLDG. 201, WALNUT AVE.
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City | MARE ISLAND
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State | CA
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Zip | 94592
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Country | US
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Telephone | 707-562-8294
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Fax |
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Provider Business Mailing Address
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Address Line | 3521 CROWNRIDGE DR
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City | FAIRFIELD
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State | CA
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Zip | 94534-7925
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Country | US
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Telephone | 707-562-8294
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 31912
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License Number State | CA
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