Provider Demographics
NPI:1518043827
Name:VESCIO, RONALD HOWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:HOWARD
Last Name:VESCIO
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:PO BOX 270040
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55127-0040
Mailing Address - Country:US
Mailing Address - Phone:651-631-3777
Mailing Address - Fax:651-631-2661
Practice Address - Street 1:2677 INNSBRUCK DR
Practice Address - Street 2:SUITE B
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-6395
Practice Address - Country:US
Practice Address - Phone:651-631-3777
Practice Address - Fax:651-631-2661
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND91241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice