Healthcare Provider Details

I. General information

NPI: 1760538904
Provider Name (Legal Business Name): RONALD S. ACQUARO, D.M.,D.,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2007
Last Update Date: 04/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5714 21ST AVE W
BRADENTON FL
34209-5606
US

IV. Provider business mailing address

5714 21ST AVE W
BRADENTON FL
34209-5606
US

V. Phone/Fax

Practice location:
  • Phone: 941-792-6272
  • Fax:
Mailing address:
  • Phone: 941-792-6272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. RONALD S. ACQUARO
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 941-792-6272