Healthcare Provider Details

I. General information

NPI: 1700868205
Provider Name (Legal Business Name): RONALD IRA ACKERMAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3460 OLD WASHINGTON RD SUITE 301
WALDORF MD
20602
US

IV. Provider business mailing address

3460 OLD WASHINGTON RD STE 301A
WALDORF MD
20602-3243
US

V. Phone/Fax

Practice location:
  • Phone: 301-645-8222
  • Fax:
Mailing address:
  • Phone: 301-645-8222
  • Fax: 301-638-9032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number07323
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: