Healthcare Provider Details

I. General information

NPI: 1992871677
Provider Name (Legal Business Name): RONALD K KAMPAS DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7011 CRIDER RD SUITE 104
MARS PA
16046-2383
US

IV. Provider business mailing address

7011 CRIDER RD SUITE 104
MARS PA
16046-2383
US

V. Phone/Fax

Practice location:
  • Phone: 724-772-8888
  • Fax: 724-772-2048
Mailing address:
  • Phone: 724-772-8888
  • Fax: 724-772-2048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS027794L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: