Provider Demographics
NPI:1033245543
Name:RONALD CONCIALDI DDS PC
Entity Type:Organization
Organization Name:RONALD CONCIALDI DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:CONCIALDI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-545-3070
Mailing Address - Street 1:2037 JERRY MURPHY RD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001
Mailing Address - Country:US
Mailing Address - Phone:719-545-3070
Mailing Address - Fax:719-545-3071
Practice Address - Street 1:2037 JERRY MURPHY RD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001
Practice Address - Country:US
Practice Address - Phone:719-545-3070
Practice Address - Fax:719-545-3071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COHD 100342122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty