Provider Demographics
NPI:1760493050
Name:LESE, RONALD JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JOHN
Last Name:LESE
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 1:105 N PARK LN
Mailing Address - Street 2:
Mailing Address - City:MISHICOT
Mailing Address - State:WI
Mailing Address - Zip Code:54228-9537
Mailing Address - Country:US
Mailing Address - Phone:920-755-2336
Mailing Address - Fax:920-755-4930
Practice Address - Street 1:105 N PARK LN
Practice Address - Street 2:
Practice Address - City:MISHICOT
Practice Address - State:WI
Practice Address - Zip Code:54228-9537
Practice Address - Country:US
Practice Address - Phone:920-755-2336
Practice Address - Fax:920-755-4930
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4001704-015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist