MEDICARE: DR. RONALD L TRIPLETT DMD

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	14445	MO

General Provider Information

NPI Number	:	1922162668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD L TRIPLETT DMD

Provider Business Mailing Address
First Line	:	11600 MANCHESTER RD
Second Line	:	SUITE 202
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-4691
Country	:	US
Telephone Number	:	314-909-1717
Fax Number	:	314-909-6681

Provider Business Practice Location Address
First Line	:	11600 MANCHESTER RD
Second Line	:	SUITE 202
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-4691
Country	:	US
Telephone Number	:	314-909-1717
Fax Number	:	314-909-6681

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	07/08/2007

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