Provider Demographics
NPI:1609958578
Name:STATLER, RONALD N (DMD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:N
Last Name:STATLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BEAVER DR
Mailing Address - Street 2:#8
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-2401
Mailing Address - Country:US
Mailing Address - Phone:814-371-4970
Mailing Address - Fax:814-371-5152
Practice Address - Street 1:11 BEAVER DR
Practice Address - Street 2:#8
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2401
Practice Address - Country:US
Practice Address - Phone:814-371-4970
Practice Address - Fax:814-371-5152
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021732L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice