Healthcare Provider Details

I. General information

NPI: 1528506102
Provider Name (Legal Business Name): RONALD L. DENTON, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 02/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 S DETROIT ST
LAGRANGE IN
46761
US

IV. Provider business mailing address

612 S DETROIT ST
LAGRANGE IN
46761-2314
US

V. Phone/Fax

Practice location:
  • Phone: 260-463-2111
  • Fax: 260-463-7496
Mailing address:
  • Phone: 260-463-2111
  • Fax: 260-463-7496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7103
License Number StateIN

VIII. Authorized Official

Name: DR. RONALD LEE DENTON
Title or Position: DENTIST/OWNER
Credential: D.D.S
Phone: 260-463-2111