Provider Demographics
NPI:1134640006
Name:PIRTLE, RONNA ROWLAND (DMD)
Entity type:Individual
Prefix:DR
First Name:RONNA
Middle Name:ROWLAND
Last Name:PIRTLE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:RONNA
Other - Middle Name:LEIGH
Other - Last Name:ROWLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1007 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-5919
Mailing Address - Country:US
Mailing Address - Phone:912-387-5571
Mailing Address - Fax:
Practice Address - Street 1:1007 BROAD ST
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-5919
Practice Address - Country:US
Practice Address - Phone:334-297-2990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-30
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0154521223G0001X
ALD-0006991-C1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice