Provider Demographics
NPI:1376671966
Name:PIRO, RONNIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONNIE
Middle Name:
Last Name:PIRO
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 1:6278 N CICERO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-4918
Mailing Address - Country:US
Mailing Address - Phone:773-202-9955
Mailing Address - Fax:773-202-9957
Practice Address - Street 1:6278 N CICERO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-4918
Practice Address - Country:US
Practice Address - Phone:773-202-9955
Practice Address - Fax:773-202-9957
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2008-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190257291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL103068Medicaid
IL1005329Medicaid