Provider Demographics
NPI:1194924308
Name:GARNER, RONALD RAYMOND (DDS)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:RAYMOND
Last Name:GARNER
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 1:1235 W VISTA WAY STE K
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6234
Mailing Address - Country:US
Mailing Address - Phone:760-724-2113
Mailing Address - Fax:760-724-2365
Practice Address - Street 1:612 E VISTA WAY
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-5546
Practice Address - Country:US
Practice Address - Phone:760-724-2113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27520122300000X
CADDS275201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist