Healthcare Provider Details

I. General information

NPI: 1427256684
Provider Name (Legal Business Name): RONALD LOUIS DICHIARA DMD PC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 PATTON CHAPEL ROAD SUITE 100
HOOVER AL
35216
US

IV. Provider business mailing address

2040 PATTON CHAPEL ROAD SUITE 100
HOOVER AL
35216
US

V. Phone/Fax

Practice location:
  • Phone: 205-979-6704
  • Fax: 205-979-6759
Mailing address:
  • Phone: 205-979-6704
  • Fax: 205-979-6759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number3580
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: