Provider Demographics
NPI:1780705475
Name:DRS RONALD & CHRISTOPHER DILEO
Entity type:Organization
Organization Name:DRS RONALD & CHRISTOPHER DILEO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:T
Authorized Official - Last Name:DILEO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-821-0422
Mailing Address - Street 1:4104 W TILGHMAN STREET
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104
Mailing Address - Country:US
Mailing Address - Phone:610-821-0422
Mailing Address - Fax:610-821-9018
Practice Address - Street 1:4104 W TILGHMAN STREET
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104
Practice Address - Country:US
Practice Address - Phone:610-821-0422
Practice Address - Fax:610-821-9018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS014226L204E00000X
PADS027267L204E00000X
PADA014226A207L00000X
PADA027267A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
01189601OtherCAPITAL BLUE CROSS RONALD
01189501OtherCAPITAL BLUE CROSS C DILE
0041091000OtherINDEPENDENCE BLUE SHIELD
0198226000OtherINDEPENDENCE BLUE SHIELD
01189601OtherCAPITAL BLUE CROSS RONALD
01189501OtherCAPITAL BLUE CROSS C DILE
U37521Medicare UPIN
114028Medicare ID - Type UnspecifiedCHRISTOPHER DILEO