Provider Demographics
NPI:1013560739
Name:RONCAGLIONE, LOUIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:
Last Name:RONCAGLIONE
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 1:1331 W MOREHEAD ST APT 403
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-5381
Mailing Address - Country:US
Mailing Address - Phone:304-941-3003
Mailing Address - Fax:
Practice Address - Street 1:8815 CHRISTENBURY PKWAY
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28207
Practice Address - Country:US
Practice Address - Phone:704-264-0253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11568122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist