Provider Demographics
NPI:1588978860
Name:DEAN, RONALD CHARLES (LMP)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:CHARLES
Last Name:DEAN
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 FARALLONE AVE
Mailing Address - Street 2:
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6700
Mailing Address - Country:US
Mailing Address - Phone:253-677-9368
Mailing Address - Fax:
Practice Address - Street 1:9873 BRIDGEPORT WAY SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2895
Practice Address - Country:US
Practice Address - Phone:253-677-9368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60168178173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist