MEDICARE: DR. RONALD G. DESKIN 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	122300000X	Dentist	5825	KS

General Provider Information

NPI Number	:	1770563157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD G. DESKIN D.D.S.

Provider Business Mailing Address
First Line	:	4527 RAINBOW BLVD.
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66103
Country	:	US
Telephone Number	:	913-432-0765
Fax Number	:	913-432-6022

Provider Business Practice Location Address
First Line	:	4527 RAINBOW BLVD
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66103-3428
Country	:	US
Telephone Number	:	913-432-0765
Fax Number	:	913-432-6022

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

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	08/28/2008

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