Provider Demographics
NPI:1558560318
Name:DUFFY, RONALD LEO (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LEO
Last Name:DUFFY
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 1:1454 E HUEBBE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-1714
Mailing Address - Country:US
Mailing Address - Phone:608-362-0672
Mailing Address - Fax:608-362-4960
Practice Address - Street 1:1454 E HUEBBE PARKWAY
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-1714
Practice Address - Country:US
Practice Address - Phone:608-362-0672
Practice Address - Fax:608-362-4960
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50004060151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice