Healthcare Provider Details

I. General information

NPI: 1679741698
Provider Name (Legal Business Name): RONALD CHARLES PUTZLER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 W GALENA BLVD SUITE 5
AURORA IL
60506-4319
US

IV. Provider business mailing address

1940 W GALENA BLVD SUITE 5
AURORA IL
60506-4319
US

V. Phone/Fax

Practice location:
  • Phone: 630-892-8794
  • Fax:
Mailing address:
  • Phone: 630-892-8794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number19018657
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: