MEDICARE: DR. RONALD JOHN GRYCKO 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	1223G0001X	General Practice Dentistry	30018618	OH

General Provider Information

NPI Number	:	1902905656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD JOHN GRYCKO DDS

Provider Business Mailing Address
First Line	:	9050 PLAINFIELD ROAD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45236-1200
Country	:	US
Telephone Number	:	513-791-3138
Fax Number	:	513-791-3139

Provider Business Practice Location Address
First Line	:	9050 PLAINFIELD ROAD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45236-1200
Country	:	US
Telephone Number	:	513-791-3138
Fax Number	:	513-791-3139

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

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	07/08/2007

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