Provider Demographics
NPI:1225486293
Name:EASTERN PLAINS LLC
Entity Type:Organization
Organization Name:EASTERN PLAINS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:P
Authorized Official - Last Name:RONCO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:719-347-3212
Mailing Address - Street 1:P.O. BOX 41
Mailing Address - Street 2:
Mailing Address - City:CALHAN
Mailing Address - State:CO
Mailing Address - Zip Code:80808
Mailing Address - Country:US
Mailing Address - Phone:719-347-3212
Mailing Address - Fax:
Practice Address - Street 1:550 FIFTH ST.
Practice Address - Street 2:
Practice Address - City:CALHAN
Practice Address - State:CO
Practice Address - Zip Code:80808
Practice Address - Country:US
Practice Address - Phone:719-347-3212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO94481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty