Provider Demographics
NPI:1841332541
Name:OMMEN, RONALD (DDS)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
Last Name:OMMEN
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 1:4820 W TAFT RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-2800
Mailing Address - Country:US
Mailing Address - Phone:315-457-3551
Mailing Address - Fax:
Practice Address - Street 1:4820 W TAFT RD
Practice Address - Street 2:SUITE 112
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-2800
Practice Address - Country:US
Practice Address - Phone:315-457-3551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042172-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice