Provider Demographics
NPI:1871609792
Name:HOUSEHOLDER, RONALD WAYNE (DDS)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:WAYNE
Last Name:HOUSEHOLDER
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:PO BOX 542
Mailing Address - Street 2:
Mailing Address - City:NORTH TAZEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:24630
Mailing Address - Country:US
Mailing Address - Phone:276-988-7522
Mailing Address - Fax:276-988-5866
Practice Address - Street 1:316 BEN BOLT AVENUE
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:VA
Practice Address - Zip Code:24651
Practice Address - Country:US
Practice Address - Phone:276-988-7522
Practice Address - Fax:276-988-5866
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010057921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice