Provider Demographics
NPI:1669455804
Name:UPPLEGER, RONALD L JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:L
Last Name:UPPLEGER
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:23077 GREENFIELD RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3732
Mailing Address - Country:US
Mailing Address - Phone:248-559-8818
Mailing Address - Fax:248-559-6884
Practice Address - Street 1:23077 GREENFIELD RD
Practice Address - Street 2:SUITE 350
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3732
Practice Address - Country:US
Practice Address - Phone:248-559-8818
Practice Address - Fax:248-559-6884
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID12856122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist