Provider Demographics
NPI:1093822215
Name:POLTERA, RONALD L (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:L
Last Name:POLTERA
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 1:107 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67156-2442
Mailing Address - Country:US
Mailing Address - Phone:620-221-9580
Mailing Address - Fax:620-221-6075
Practice Address - Street 1:107 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156-2442
Practice Address - Country:US
Practice Address - Phone:620-221-9580
Practice Address - Fax:620-221-6075
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS52811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice