Provider Demographics
NPI:1467572198
Name:SCORNAVACCA, RONALD J (DMD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:J
Last Name:SCORNAVACCA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9727 GREENSIDE DR
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-5030
Mailing Address - Country:US
Mailing Address - Phone:410-667-6404
Mailing Address - Fax:410-628-2248
Practice Address - Street 1:9727 GREENSIDE DR
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-5030
Practice Address - Country:US
Practice Address - Phone:410-667-6404
Practice Address - Fax:410-628-2248
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD49291223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics