Provider Demographics
NPI:1780747659
Name:ROESSLER, RONALD K (DMD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:K
Last Name:ROESSLER
Suffix:
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 1:1529 MARGARET ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-3821
Mailing Address - Country:US
Mailing Address - Phone:904-356-4880
Mailing Address - Fax:904-358-0704
Practice Address - Street 1:1529 MARGARET ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-3821
Practice Address - Country:US
Practice Address - Phone:904-356-4880
Practice Address - Fax:904-358-0704
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN149311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice