Provider Demographics
NPI:1285219204
Name:RONNIE ATA CONSULTING
Entity Type:Organization
Organization Name:RONNIE ATA CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ATA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-340-2950
Mailing Address - Street 1:12601 WESTERN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-1777
Mailing Address - Country:US
Mailing Address - Phone:708-293-1903
Mailing Address - Fax:708-293-1909
Practice Address - Street 1:12601 WESTERN AVE STE B
Practice Address - Street 2:
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-1777
Practice Address - Country:US
Practice Address - Phone:708-293-1903
Practice Address - Fax:708-293-1909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty