MEDICARE: DR. RONALD B. CARMEN D.D.S., M.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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	14389	OH

General Provider Information

NPI Number	:	1538360078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. RONALD B. CARMEN D.D.S., M.S.

Provider Business Mailing Address
First Line	:	5225 E MAIN ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-2503
Country	:	US
Telephone Number	:	614-864-5555
Fax Number	:	614-759-4444

Provider Business Practice Location Address
First Line	:	5225 E MAIN ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-2503
Country	:	US
Telephone Number	:	614-864-5555
Fax Number	:	614-759-4444

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. KRISTIE RUSS
Credential	:
Telephone Number	:	614-864-5555

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	10/16/2014

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