Provider Demographics
NPI:1376605386
Name:SIMONSEN, RONALD WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:WILLIAM
Last Name:SIMONSEN
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 1:33009 POPHAM LN
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-5770
Mailing Address - Country:US
Mailing Address - Phone:440-248-8415
Mailing Address - Fax:
Practice Address - Street 1:10441 VALLEY VIEW RD
Practice Address - Street 2:
Practice Address - City:MACEDONIA
Practice Address - State:OH
Practice Address - Zip Code:44056-1746
Practice Address - Country:US
Practice Address - Phone:330-468-2634
Practice Address - Fax:330-468-2637
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0195971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice