Provider Demographics
NPI:1316099831
Name:JOHNS, R. RONALD (DDS)
Entity type:Individual
Prefix:DR
First Name:R.
Middle Name:RONALD
Last Name:JOHNS
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 1:1580 E WASHINGTON ST
Mailing Address - Street 2:SUITE # 105
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-3679
Mailing Address - Country:US
Mailing Address - Phone:707-763-1959
Mailing Address - Fax:707-763-6381
Practice Address - Street 1:1580 E WASHINGTON ST
Practice Address - Street 2:SUITE # 105
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-3679
Practice Address - Country:US
Practice Address - Phone:707-763-1959
Practice Address - Fax:707-763-6381
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice