Provider Demographics
NPI:1013187806
Name:PARDUN, ROLAND W (DDS)
Entity Type:Individual
Prefix:
First Name:ROLAND
Middle Name:W
Last Name:PARDUN
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 36
Mailing Address - Street 2:
Mailing Address - City:COCHRANE
Mailing Address - State:WI
Mailing Address - Zip Code:54622-0036
Mailing Address - Country:US
Mailing Address - Phone:608-248-2442
Mailing Address - Fax:608-248-3132
Practice Address - Street 1:241 N MAIN ST
Practice Address - Street 2:
Practice Address - City:COCHRANE
Practice Address - State:WI
Practice Address - Zip Code:54622
Practice Address - Country:US
Practice Address - Phone:608-248-2442
Practice Address - Fax:608-248-3132
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50016931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice