=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528574548
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RONALD W ORR JR DDS & PATRICIA A WILSON DDS & ASSOCIATES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2017
-----------------------------------------------------
Last Update Date | 12/28/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13494 CEDAR ROAD
-----------------------------------------------------
City | UNIVERSITY HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-932-9400
-----------------------------------------------------
Fax | 216-932-9454
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13494 CEDAR ROAD
-----------------------------------------------------
City | UNIVERSITY HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-932-9400
-----------------------------------------------------
Fax | 216-932-9454
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. RONALD W ORR JR.
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 216-932-9400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------