Provider Demographics
NPI:1558147504
Name:SANTANA, RONALDO BARCELLOS DE (DDS, MSCD, DSC)
Entity Type:Individual
Prefix:DR
First Name:RONALDO
Middle Name:BARCELLOS DE
Last Name:SANTANA
Suffix:
Gender:M
Credentials:DDS, MSCD, DSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 RIGHTERS FERRY RD APT 204
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1742
Mailing Address - Country:US
Mailing Address - Phone:610-233-6872
Mailing Address - Fax:
Practice Address - Street 1:3223 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5007
Practice Address - Country:US
Practice Address - Phone:610-233-6872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARFD0000611223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics