Provider Demographics
NPI:1003960360
Name:ALBERT, RONALD J (DMD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:J
Last Name:ALBERT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 TOLLAND TPKE
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-1771
Mailing Address - Country:US
Mailing Address - Phone:860-649-5000
Mailing Address - Fax:
Practice Address - Street 1:360 TOLLAND TPKE
Practice Address - Street 2:SUITE 2B
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-1771
Practice Address - Country:US
Practice Address - Phone:860-649-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT65311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice