Provider Demographics
NPI:1609856145
Name:CLEVERLEY, RONALD GUY (DDS, PA)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:GUY
Last Name:CLEVERLEY
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:KS
Mailing Address - Zip Code:66736-1315
Mailing Address - Country:US
Mailing Address - Phone:620-378-2001
Mailing Address - Fax:620-378-4697
Practice Address - Street 1:428 N 7TH ST
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:KS
Practice Address - Zip Code:66736-1315
Practice Address - Country:US
Practice Address - Phone:620-378-2001
Practice Address - Fax:620-378-4697
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS46631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice