Provider Demographics
NPI:1942264445
Name:DICARLO, RONALD ANTHONY II (DMD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:ANTHONY
Last Name:DICARLO
Suffix:II
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:J R
Other - Middle Name:
Other - Last Name:DICARLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:1111 RIATA VALLEY RD
Mailing Address - Street 2:STE 300
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409
Mailing Address - Country:US
Mailing Address - Phone:928-757-8700
Mailing Address - Fax:928-757-0399
Practice Address - Street 1:1111 RIATA VALLEY RD
Practice Address - Street 2:STE 300
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409
Practice Address - Country:US
Practice Address - Phone:928-757-8700
Practice Address - Fax:928-757-0399
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ60611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice