Provider Demographics
NPI:1245544378
Name:GASPARD, RONALD ANTHONY III (DDS)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:ANTHONY
Last Name:GASPARD
Suffix:III
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 1:2211 S 64TH PLZ # 233
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-2805
Mailing Address - Country:US
Mailing Address - Phone:402-212-6349
Mailing Address - Fax:
Practice Address - Street 1:5321 CENTER ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-2338
Practice Address - Country:US
Practice Address - Phone:402-551-2238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6915122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47071268413Medicaid