Provider Demographics
NPI:1689872285
Name:RONCO, RONALD PAUL (DMD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:PAUL
Last Name:RONCO
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 1:3605 STAR RANCH RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-5980
Mailing Address - Country:US
Mailing Address - Phone:719-576-3276
Mailing Address - Fax:719-576-1544
Practice Address - Street 1:3605 STAR RANCH RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-5980
Practice Address - Country:US
Practice Address - Phone:719-576-3276
Practice Address - Fax:719-576-1544
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO94481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice