Healthcare Provider Details

I. General information

NPI: 1013922475
Provider Name (Legal Business Name): RONALD D. THOMAN DDS., PC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7730 N UNION BLVD SUITE 103
COLORADO SPRINGS CO
80920-4084
US

IV. Provider business mailing address

7730 N UNION BLVD SUITE 103
COLORADO SPRINGS CO
80920-4084
US

V. Phone/Fax

Practice location:
  • Phone: 719-590-1500
  • Fax: 719-590-9379
Mailing address:
  • Phone: 719-590-1500
  • Fax: 719-590-9379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number6376
License Number StateCO

VIII. Authorized Official

Name: DR. RONALD D THOMAN
Title or Position: PRESIDENT
Credential: DDS
Phone: 719-590-1500