Provider Demographics
NPI:1225204092
Name:RONCONE, RONALD (DDS)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:RONCONE
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 1:221 MAIN ST
Mailing Address - Street 2:#100
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-6054
Mailing Address - Country:US
Mailing Address - Phone:760-758-0630
Mailing Address - Fax:
Practice Address - Street 1:221 MAIN ST
Practice Address - Street 2:#100
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-6054
Practice Address - Country:US
Practice Address - Phone:760-758-0630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA232381223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics