Provider Demographics
NPI:1528137064
Name:SERSHON, RONALD BRIAN (DDS)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:BRIAN
Last Name:SERSHON
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 1:2909 E. PARK AVE.
Mailing Address - Street 2:CVCTF HSU DENTAL
Mailing Address - City:CHIPPEWA FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54729
Mailing Address - Country:US
Mailing Address - Phone:608-739-2690
Mailing Address - Fax:
Practice Address - Street 1:2909 E. PARK AVE.
Practice Address - Street 2:CVCTF HSU DENTAL
Practice Address - City:CHIPPEWA FALLS
Practice Address - State:WI
Practice Address - Zip Code:54729
Practice Address - Country:US
Practice Address - Phone:608-739-2690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6287-15122300000X
IL0190186871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice