MEDICARE: RONALD GENE SHRADER D.D.S.

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	1223G0001X	General Practice Dentistry	18502	CA

General Provider Information

NPI Number	:	1285638270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD GENE SHRADER D.D.S.

Provider Business Mailing Address
First Line	:	7154 MAGNOLIA AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92504-3804
Country	:	US
Telephone Number	:	951-686-3666
Fax Number	:	951-686-3674

Provider Business Practice Location Address
First Line	:	7154 MAGNOLIA AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92504-3804
Country	:	US
Telephone Number	:	951-686-3666
Fax Number	:	951-686-3674

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	02/20/2008

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