Provider Demographics
NPI:1629057088
Name:ROHOLT, RONALD L (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:L
Last Name:ROHOLT
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 CAMPUS DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846
Mailing Address - Country:US
Mailing Address - Phone:620-272-0100
Mailing Address - Fax:620-271-0160
Practice Address - Street 1:311 CAMPUS DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846
Practice Address - Country:US
Practice Address - Phone:620-272-0100
Practice Address - Fax:620-271-0160
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS603431223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSV06414Medicare UPIN
KS116901Medicare PIN