Provider Demographics
NPI:1700938800
Name:PAHL, RONALD A JR (DMD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:A
Last Name:PAHL
Suffix:JR
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 1:1182 SPRINGFIELD ST
Mailing Address - Street 2:
Mailing Address - City:FEEDING HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:01030-2115
Mailing Address - Country:US
Mailing Address - Phone:413-786-7313
Mailing Address - Fax:413-786-7542
Practice Address - Street 1:1182 SPRINGFIELD ST
Practice Address - Street 2:
Practice Address - City:FEEDING HILLS
Practice Address - State:MA
Practice Address - Zip Code:01030-2115
Practice Address - Country:US
Practice Address - Phone:413-786-7313
Practice Address - Fax:413-786-7542
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA180251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0277819Medicare ID - Type Unspecified