MEDICARE: OLENA RONAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	061622	NY

General Provider Information

NPI Number	:	1144711755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLENA RONAN DDS

Provider Business Mailing Address
First Line	:	81 NARROWS RD N APT D
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-2818
Country	:	US
Telephone Number	:	312-274-4524
Fax Number	:

Provider Business Practice Location Address
First Line	:	1735 RICHMOND AVE FL 2
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3907
Country	:	US
Telephone Number	:	347-391-4393
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2018
Last Update Date	:	08/21/2023

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