Provider Demographics
NPI:1720248537
Name:RUCHONG, RONALD C (DDS)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:C
Last Name:RUCHONG
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 1:604 HARRIS STREET
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-4448
Mailing Address - Country:US
Mailing Address - Phone:707-443-8064
Mailing Address - Fax:707-443-0344
Practice Address - Street 1:604 HARRIS STREET
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-4448
Practice Address - Country:US
Practice Address - Phone:707-443-8064
Practice Address - Fax:707-443-0344
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice