Provider Demographics
NPI:1457781262
Name:CONCIALDI, RON (DDS)
Entity type:Individual
Prefix:MR
First Name:RON
Middle Name:
Last Name:CONCIALDI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:RONALD
Other - Middle Name:
Other - Last Name:CONCIALDI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2037 JERRY MURPHY RD.
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001
Mailing Address - Country:US
Mailing Address - Phone:719-545-3070
Mailing Address - Fax:719-545-3071
Practice Address - Street 1:2037 JERRY MURPHY RD.
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001
Practice Address - Country:US
Practice Address - Phone:719-545-3070
Practice Address - Fax:719-545-3071
Is Sole Proprietor?:No
Enumeration Date:2013-11-14
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COHD100342122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist