MEDICARE: DR. RONALD GORDON PIROK DDS

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	122300000X	Dentist	DS19260L	PA

General Provider Information

NPI Number	:	1568429827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD GORDON PIROK DDS

Provider Business Mailing Address
First Line	:	1741 S FORGE MOUNTAIN RD
Second Line	:
City	:	VALLEY FORGE
State	:	PA
Zip	:	19481
Country	:	US
Telephone Number	:	610-783-6313
Fax Number	:

Provider Business Practice Location Address
First Line	:	3550 MARKET ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104
Country	:	US
Telephone Number	:	215-387-0883
Fax Number	:	215-387-9659

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

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	07/08/2007

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