Provider Demographics
NPI:1073571493
Name:RONGEY, WALTER FRANCIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:FRANCIS
Last Name:RONGEY
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:ILLIANA VA MEDICAL CENTER, DENTAL SERVICE
Mailing Address - Street 2:1900 E. MAIN STREET
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832
Mailing Address - Country:US
Mailing Address - Phone:217-554-5859
Mailing Address - Fax:217-554-5863
Practice Address - Street 1:205 KASBERG DR
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-6342
Practice Address - Country:US
Practice Address - Phone:254-654-0578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0207251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice