Provider Demographics
NPI:1700976081
Name:RUMBAUGH, RONALD LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LEE
Last Name:RUMBAUGH
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 1:4207 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-7219
Mailing Address - Country:US
Mailing Address - Phone:260-426-3401
Mailing Address - Fax:260-424-3007
Practice Address - Street 1:4207 LAKE AVE
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-7219
Practice Address - Country:US
Practice Address - Phone:260-426-3401
Practice Address - Fax:260-424-3007
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN8140122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist