MEDICARE: DR. RONALD OWEN DAVIES DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223D0004X	Dental Anesthesiology	24762	CA

General Provider Information

NPI Number	:	1013113414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD OWEN DAVIES DDS

Provider Business Mailing Address
First Line	:	28241 CROWN VALLEY PKY PMB 620
Second Line	:	STE F 620
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92677
Country	:	US
Telephone Number	:	949-362-9690
Fax Number	:	949-448-8858

Provider Business Practice Location Address
First Line	:	28241 CROWN VALLEY PKWY PMB 620
Second Line	:	STE. F 620
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92677-4441
Country	:	US
Telephone Number	:	949-362-9690
Fax Number	:	949-448-8858

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	05/16/2013

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