Provider Demographics
NPI:1700868205
Name:ACKERMAN, RONALD IRA (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:IRA
Last Name:ACKERMAN
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 1:3460 OLD WASHINGTON RD STE 301A
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3243
Mailing Address - Country:US
Mailing Address - Phone:301-645-8222
Mailing Address - Fax:301-638-9032
Practice Address - Street 1:3460 OLD WASHINGTON RD
Practice Address - Street 2:SUITE 301
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602
Practice Address - Country:US
Practice Address - Phone:301-645-8222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD073231223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1035OtherBLUE CROSS BLUE SHIELD
MD162238OtherUNITED CONCORDIA COMPANY