Provider Demographics
NPI:1437451481
Name:RONALD CORLEY, DDS
Entity Type:Organization
Organization Name:RONALD CORLEY, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:K
Authorized Official - Last Name:CORLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-326-7530
Mailing Address - Street 1:614 ANDREW AVE
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-4677
Mailing Address - Country:US
Mailing Address - Phone:219-326-7530
Mailing Address - Fax:219-326-7531
Practice Address - Street 1:614 ANDREW AVE
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-4677
Practice Address - Country:US
Practice Address - Phone:219-326-7530
Practice Address - Fax:219-326-7531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty