Healthcare Provider Details

I. General information

NPI: 1740263169
Provider Name (Legal Business Name): CHRISTOPHER RONCONE D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32140 US HIGHWAY 79 SUITE 201
TEMECULA CA
92592-9509
US

IV. Provider business mailing address

32140 US HIGHWAY 79 SUITE 201
TEMECULA CA
92592-9509
US

V. Phone/Fax

Practice location:
  • Phone: 951-302-9911
  • Fax:
Mailing address:
  • Phone: 951-302-9911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number43557
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: