Provider Demographics
NPI:1093908337
Name:WANEK, RONALD MELVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:MELVIN
Last Name:WANEK
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 1:4915 MONONA DR
Mailing Address - Street 2:
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716-2665
Mailing Address - Country:US
Mailing Address - Phone:608-222-7077
Mailing Address - Fax:
Practice Address - Street 1:4915 MONONA DR
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-2665
Practice Address - Country:US
Practice Address - Phone:608-222-7077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50001061223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics