=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235024605
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RORO ENTERPRISES PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2025
-----------------------------------------------------
Last Update Date | 06/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3520 S SHELDON LN
-----------------------------------------------------
City | SIOUX FALLS
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57105-6121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-247-0953
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7622 LOST MINE PEAK
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78240-4581
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 320-247-0953
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CONSULTANT
-----------------------------------------------------
Name | DR. MATTHEW FORD
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 320-247-0953
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------