Provider Demographics
NPI:1609989060
Name:BARONE, ROY NICHOLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:NICHOLAS
Last Name:BARONE
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:PO BOX 1055
Mailing Address - Street 2:
Mailing Address - City:COFFEYVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:67337-0911
Mailing Address - Country:US
Mailing Address - Phone:620-251-3560
Mailing Address - Fax:620-251-5661
Practice Address - Street 1:808 WILLOW ST
Practice Address - Street 2:
Practice Address - City:COFFEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:67337-5851
Practice Address - Country:US
Practice Address - Phone:620-251-3560
Practice Address - Fax:620-251-5661
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS62011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice