Provider Demographics
NPI:1538360078
Name:DR. RONALD B. CARMEN D.D.S., M.S.
Entity type:Organization
Organization Name:DR. RONALD B. CARMEN D.D.S., M.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-864-5555
Mailing Address - Street 1:5225 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2503
Mailing Address - Country:US
Mailing Address - Phone:614-864-5555
Mailing Address - Fax:614-759-4444
Practice Address - Street 1:5225 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2503
Practice Address - Country:US
Practice Address - Phone:614-864-5555
Practice Address - Fax:614-759-4444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH143891223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty