Provider Demographics
NPI:1215084934
Name:HERMES, RONALD CLAYTON (DDS)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:CLAYTON
Last Name:HERMES
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 1:6930 FERN AVENUE, SUITE 100
Mailing Address - Street 2:
Mailing Address - City:SHREVPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105
Mailing Address - Country:US
Mailing Address - Phone:318-797-9997
Mailing Address - Fax:
Practice Address - Street 1:7101 PINES RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71129-3403
Practice Address - Country:US
Practice Address - Phone:318-688-2970
Practice Address - Fax:318-688-2972
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA32921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice