Provider Demographics
NPI:1750469011
Name:CROTEAU, RONALD JOHN (DDS)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:JOHN
Last Name:CROTEAU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:RONALD
Other - Middle Name:J
Other - Last Name:CROTEAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PLLC
Mailing Address - Street 1:1207 MORGANTOWN AVENUE
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-4503
Mailing Address - Country:US
Mailing Address - Phone:304-366-7002
Mailing Address - Fax:304-366-7020
Practice Address - Street 1:1207 MORGANTOWN AVENUE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-4503
Practice Address - Country:US
Practice Address - Phone:304-366-7002
Practice Address - Fax:304-366-7020
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2183122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0134953000Medicaid