Provider Demographics
NPI:1881601656
Name:LUONGO, RALPH PATRICK JR (DDS)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:PATRICK
Last Name:LUONGO
Suffix:JR
Gender:
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:W3275 WOLF RIVER DR
Mailing Address - Street 2:
Mailing Address - City:KESHENA
Mailing Address - State:WI
Mailing Address - Zip Code:54135-9202
Mailing Address - Country:US
Mailing Address - Phone:715-799-3960
Mailing Address - Fax:
Practice Address - Street 1:W3275 WOLF RIVER DR
Practice Address - Street 2:
Practice Address - City:KESHENA
Practice Address - State:WI
Practice Address - Zip Code:54135-9202
Practice Address - Country:US
Practice Address - Phone:715-799-3960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4802122300000X
AZ5561122300000X
NMDD3700122300000X
WI6001279-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM04331745Medicaid