Provider Demographics
NPI:1821143843
Name:RONKIN, KONSTANTIN (DMD)
Entity Type:Individual
Prefix:
First Name:KONSTANTIN
Middle Name:
Last Name:RONKIN
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 1:719 BAY RD
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-1506
Mailing Address - Country:US
Mailing Address - Phone:781-828-4568
Mailing Address - Fax:
Practice Address - Street 1:2184 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-1145
Practice Address - Country:US
Practice Address - Phone:781-828-4568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA184201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice