Provider Demographics
NPI:1437296118
Name:VANTUYL, RONALD ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:ALLEN
Last Name:VANTUYL
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 1:3223 E 31ST ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-2452
Mailing Address - Country:US
Mailing Address - Phone:918-743-9946
Mailing Address - Fax:918-742-1021
Practice Address - Street 1:3223 E 31ST ST
Practice Address - Street 2:SUITE 108
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-2452
Practice Address - Country:US
Practice Address - Phone:918-743-9946
Practice Address - Fax:918-742-1021
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK30821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice