Provider Demographics
NPI:1063411163
Name:CHALK, RONALD J (DDS)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:J
Last Name:CHALK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8315 WALNUT HILL LN
Mailing Address - Street 2:SUITE 230
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4218
Mailing Address - Country:US
Mailing Address - Phone:214-691-6698
Mailing Address - Fax:
Practice Address - Street 1:8315 WALNUT HILL LN
Practice Address - Street 2:SUITE 230
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4218
Practice Address - Country:US
Practice Address - Phone:214-691-6698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD8754Medicare UPIN