MEDICARE: DR. RONALD L DALLESKE D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN5987	FL

General Provider Information

NPI Number	:	1346351046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD L DALLESKE D.D.S.

Provider Business Mailing Address
First Line	:	4379 GEVALIA DR
Second Line	:
City	:	BROOKSVILLE
State	:	FL
Zip	:	34604-5806
Country	:	US
Telephone Number	:	352-754-1403
Fax Number	:

Provider Business Practice Location Address
First Line	:	3429 MARINER BLVD
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34609-2463
Country	:	US
Telephone Number	:	352-666-9898
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	12/10/2013

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