Provider Demographics
NPI:1073685475
Name:MAGIERA, RONALD J (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:J
Last Name:MAGIERA
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 1:15544 CICERO AVE
Mailing Address - Street 2:
Mailing Address - City:OAK FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60452-3602
Mailing Address - Country:US
Mailing Address - Phone:708-687-0100
Mailing Address - Fax:708-687-9313
Practice Address - Street 1:15544 CICERO AVE
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-3602
Practice Address - Country:US
Practice Address - Phone:708-687-0100
Practice Address - Fax:708-687-9313
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice