Provider Demographics
NPI:1659710853
Name:ST. JOHN., RONALD KINGSLEY JR (DMD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:KINGSLEY
Last Name:ST. JOHN.
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:RON
Other - Middle Name:K
Other - Last Name:ST. JOHN
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:212 PROUTY DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-9851
Mailing Address - Country:US
Mailing Address - Phone:802-334-6965
Mailing Address - Fax:802-334-6606
Practice Address - Street 1:212 PROUTY DR
Practice Address - Street 2:SUITE 1
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-9851
Practice Address - Country:US
Practice Address - Phone:802-334-6965
Practice Address - Fax:802-334-6606
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016.0095742122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist