Healthcare Provider Details

I. General information

NPI: 1548222730
Provider Name (Legal Business Name): RONALD EDWARD PRENZEL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 LOMAS BLVD NE
ALBUQUERQUE NM
87110-6539
US

IV. Provider business mailing address

130 MONTECILLO BLVD APT 1214
EL PASO TX
79912-4934
US

V. Phone/Fax

Practice location:
  • Phone: 505-268-6388
  • Fax:
Mailing address:
  • Phone: 915-487-6023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number055981
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number60516
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number36927
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDD5435
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: