MEDICARE: DR. ROBERT W RONK D.D.S.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	30012950	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RN920864	OTHER	OH	DRIVER'S LICENSE

General Provider Information

NPI Number	:	1518083575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT W RONK D.D.S.

Provider Business Mailing Address
First Line	:	812 COSHOCTON AVE
Second Line	:
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050-1947
Country	:	US
Telephone Number	:	740-397-2111
Fax Number	:	740-397-2111

Provider Business Practice Location Address
First Line	:	812 COSHOCTON AVE
Second Line	:
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050-1947
Country	:	US
Telephone Number	:	740-397-2111
Fax Number	:	740-397-2111

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

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. ROBERT W RONK D.D.S.” Practice Location

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