Provider Demographics
NPI:1023232543
Name:SARLES, RONALD GREGORY (DDS)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:GREGORY
Last Name:SARLES
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 1:1301 BROADWAY
Mailing Address - Street 2:6
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030-1336
Mailing Address - Country:US
Mailing Address - Phone:650-588-8850
Mailing Address - Fax:650-588-2302
Practice Address - Street 1:1301 BROADWAY
Practice Address - Street 2:6
Practice Address - City:MILLBRAE
Practice Address - State:CA
Practice Address - Zip Code:94030-1336
Practice Address - Country:US
Practice Address - Phone:650-588-8850
Practice Address - Fax:650-588-2302
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADD0348971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice