Provider Demographics
NPI:1700899176
Name:RONZO, KENNETH RALPH (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:RALPH
Last Name:RONZO
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 1:2755 SAINT PAUL BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-3751
Mailing Address - Country:US
Mailing Address - Phone:585-342-9027
Mailing Address - Fax:585-342-5898
Practice Address - Street 1:2615 CULVER RD
Practice Address - Street 2:SUITE #200
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-1746
Practice Address - Country:US
Practice Address - Phone:585-467-2745
Practice Address - Fax:585-467-5683
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0384991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7692KROtherEXCELLUS BC/BS PROVIDER I