Provider Demographics
NPI:1316957962
Name:SMITH, RONALD W (DDS)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:W
Last Name:SMITH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:RONALD
Other - Middle Name:W
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1749 MASS AVE
Mailing Address - Street 2:RONALD W SMITH DDS
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140
Mailing Address - Country:US
Mailing Address - Phone:617-492-1106
Mailing Address - Fax:617-661-1555
Practice Address - Street 1:1749 MASS AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140
Practice Address - Country:US
Practice Address - Phone:617-492-1106
Practice Address - Fax:617-661-1555
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA120161223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0241482Medicaid