Provider Demographics
NPI:1578666152
Name:DELUCA, RONALD DAVID (DDS)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:DAVID
Last Name:DELUCA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:MR
Other - First Name:RONALD
Other - Middle Name:D
Other - Last Name:DELUCA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:781 SUMPTER RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48111-2916
Mailing Address - Country:US
Mailing Address - Phone:734-697-5477
Mailing Address - Fax:
Practice Address - Street 1:33196 GROESBECK HWY
Practice Address - Street 2:
Practice Address - City:FRASER
Practice Address - State:MI
Practice Address - Zip Code:48026-1594
Practice Address - Country:US
Practice Address - Phone:586-415-6813
Practice Address - Fax:586-415-1041
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901010986122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist