Provider Demographics
NPI:1851449359
Name:BURKHOLDER, RONALD JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JOHN
Last Name:BURKHOLDER
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:PO BOX 9
Mailing Address - Street 2:693 CRESSMAN ROAD
Mailing Address - City:LEDERACH
Mailing Address - State:PA
Mailing Address - Zip Code:19450-0009
Mailing Address - Country:US
Mailing Address - Phone:215-513-2211
Mailing Address - Fax:
Practice Address - Street 1:MILLS DENTAL CLINIC
Practice Address - Street 2:5660 DOUGHBOY LOOP
Practice Address - City:FORT DIX
Practice Address - State:NJ
Practice Address - Zip Code:08640-5435
Practice Address - Country:US
Practice Address - Phone:609-562-2610
Practice Address - Fax:609-562-6851
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021531L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice