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General NPI Number Information
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NPI Number | 1598905192
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Entity Type | Organization
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Legal Business Name | RONALD C MAMRICK, DDS PC
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Dates
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Enumeration Date | 02/23/2009
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Last Update Date | 02/23/2009
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Provider Practice Location Address
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Address Line | 1807 HUGUENOT RD SUITE 124
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City | MIDLOTHIAN
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State | VA
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Zip | 23113-5604
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Country | US
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Telephone | 804-423-1600
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Fax | 804-423-1602
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Provider Business Mailing Address
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Address Line | 1807 HUGUENOT RD SUITE 124
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City | MIDLOTHIAN
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State | VA
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Zip | 23113-5604
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Country | US
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Telephone | 804-423-1600
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Fax | 804-423-1602
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Authorized Official
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Title or Position | PRESIDENT
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Name | RONALD MAMRICK
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Credential | DDS
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Telephone | 804-423-1600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 0401410863
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License Number State | VA
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