Provider Demographics
NPI:1699079772
Name:DR. RONALD L. DICHIARA DMD PC
Entity type:Organization
Organization Name:DR. RONALD L. DICHIARA DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:DICHIARA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-979-6704
Mailing Address - Street 1:2040 PATTON CHAPEL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35216-0701
Mailing Address - Country:US
Mailing Address - Phone:205-979-6704
Mailing Address - Fax:205-979-6759
Practice Address - Street 1:2040 PATTON CHAPEL RD STE 100
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35216-0701
Practice Address - Country:US
Practice Address - Phone:205-979-6704
Practice Address - Fax:205-979-6759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty