Provider Demographics
NPI:1891842191
Name:RONE, ROBERT HALL (DMD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:HALL
Last Name:RONE
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:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39059-0429
Mailing Address - Country:US
Mailing Address - Phone:601-892-3531
Mailing Address - Fax:601-892-3531
Practice Address - Street 1:205 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:CRYSTAL SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39059-2863
Practice Address - Country:US
Practice Address - Phone:601-892-3531
Practice Address - Fax:601-892-3531
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2689921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00660005Medicaid