Provider Demographics
NPI:1346391851
Name:POULOS, RONALD LOUIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LOUIS
Last Name:POULOS
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 1:7655 5 MILE RD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-4326
Mailing Address - Country:US
Mailing Address - Phone:513-232-0550
Mailing Address - Fax:513-232-1605
Practice Address - Street 1:7655 5 MILE RD
Practice Address - Street 2:SUITE 214
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-4326
Practice Address - Country:US
Practice Address - Phone:513-232-0550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300196331223P0221X
KY6041223P0221X
MI29010158331223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0354601Medicaid