Provider Demographics
NPI:1700961729
Name:DECKARD, RONALD E (DDS)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:E
Last Name:DECKARD
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 1:7850 N RODEO DR
Mailing Address - Street 2:
Mailing Address - City:ELLETTSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47429-9323
Mailing Address - Country:US
Mailing Address - Phone:812-876-7026
Mailing Address - Fax:
Practice Address - Street 1:7850 N RODEO DR
Practice Address - Street 2:
Practice Address - City:ELLETTSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47429-9323
Practice Address - Country:US
Practice Address - Phone:812-876-7026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007982A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice