Healthcare Provider Details

I. General information

NPI: 1346351046
Provider Name (Legal Business Name): RONALD L DALLESKE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 12/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3429 MARINER BLVD
SPRING HILL FL
34609-2463
US

IV. Provider business mailing address

4379 GEVALIA DR
BROOKSVILLE FL
34604-5806
US

V. Phone/Fax

Practice location:
  • Phone: 352-666-9898
  • Fax:
Mailing address:
  • Phone: 352-754-1403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN5987
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: