Provider Demographics
NPI:1871713784
Name:RONALD G. ROE DDS
Entity type:Organization
Organization Name:RONALD G. ROE DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:GLYNN
Authorized Official - Last Name:ROE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-621-4927
Mailing Address - Street 1:6330 CAPE WEDGEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:BROWNS SUMMIT
Mailing Address - State:NC
Mailing Address - Zip Code:27214-9692
Mailing Address - Country:US
Mailing Address - Phone:336-621-0358
Mailing Address - Fax:
Practice Address - Street 1:1430 E CONE BLVD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-4534
Practice Address - Country:US
Practice Address - Phone:336-621-4927
Practice Address - Fax:336-621-5376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4395122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty