Provider Demographics
NPI:1194879619
Name:RONAT, ARTHUR EDWARD (DDS)
Entity type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:EDWARD
Last Name:RONAT
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 1:1720 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-2930
Mailing Address - Country:US
Mailing Address - Phone:618-244-3535
Mailing Address - Fax:618-244-4342
Practice Address - Street 1:1720 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-2930
Practice Address - Country:US
Practice Address - Phone:618-244-3535
Practice Address - Fax:628-244-4342
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice