Provider Demographics
NPI:1942652037
Name:KO, RONALD MATTHEW (DMD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:MATTHEW
Last Name:KO
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 1:10211 144TH ST E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-4955
Mailing Address - Country:US
Mailing Address - Phone:206-676-2438
Mailing Address - Fax:
Practice Address - Street 1:10211 144TH ST E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-4955
Practice Address - Country:US
Practice Address - Phone:253-848-7281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2021-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.030854122300000X
WADE60810468122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist