Provider Demographics
NPI:1922193390
Name:RECEVEUR, RONALD L (DDS)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:L
Last Name:RECEVEUR
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 1:819 MOUNT TABOR RD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-6414
Mailing Address - Country:US
Mailing Address - Phone:812-948-2281
Mailing Address - Fax:812-945-8374
Practice Address - Street 1:819 MOUNT TABOR RD
Practice Address - Street 2:SUITE 10
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-6414
Practice Address - Country:US
Practice Address - Phone:812-948-2281
Practice Address - Fax:812-945-8374
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008027A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice