Healthcare Provider Details

I. General information

NPI: 1619984788
Provider Name (Legal Business Name): DR. RONALD T PLOTKA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

293 HUMPHREY ST
SWAMPSCOTT MA
01907-2548
US

IV. Provider business mailing address

293 HUMPHREY ST
SWAMPSCOTT MA
01907-2548
US

V. Phone/Fax

Practice location:
  • Phone: 781-599-8300
  • Fax:
Mailing address:
  • Phone: 781-599-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11381
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: