Healthcare Provider Details

I. General information

NPI: 1215063722
Provider Name (Legal Business Name): RONALD DEUTSCH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 05/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ALL SMILES DENTAL PC 2016 AVE M
BROOKLYN NY
11210
US

IV. Provider business mailing address

RONALD DEUTSEM DDS ALL SMILES DENTAL PC 2016 AVE M
BROOKLYN NY
11210
US

V. Phone/Fax

Practice location:
  • Phone: 718-253-2300
  • Fax: 718-252-7910
Mailing address:
  • Phone: 718-253-2300
  • Fax: 718-252-7910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number049859
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number049859
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: