Provider Demographics
NPI:1780786467
Name:BLOY, RONALD STEPHEN (DDS)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:STEPHEN
Last Name:BLOY
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 1:632 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ONEILL
Mailing Address - State:NE
Mailing Address - Zip Code:68763-1429
Mailing Address - Country:US
Mailing Address - Phone:402-336-1702
Mailing Address - Fax:
Practice Address - Street 1:30 OKI PLACE
Practice Address - Street 2:
Practice Address - City:KAUNAKAKAI
Practice Address - State:HI
Practice Address - Zip Code:96748-9674
Practice Address - Country:US
Practice Address - Phone:808-553-5038
Practice Address - Fax:808-553-3780
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HICSDT-321223G0001X
NE55631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE05239-NEOtherBC&BS OF NE PROVIDER ID #
NE470730010OtherFEDERAL T.I.N.