Ronald L Dolezal, DDS
Individual provider Active NPI Dentist · Schuyler, NE
NPI 1629104286 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1629104286
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 5641 (NE)
- Practice address
- 216 E 10TH St
Schuyler, NE 68661 - Phone
- (402) 352-2204
- NPI assigned
- Feb 26, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5641 | NE | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 5641 | NE | Yes |
Addresses
Primary practice location
216 E 10TH St
Schuyler, NE 68661
Mailing address
PO Box 67
216 E 10TH St
Schuyler, NE 68661
Phone (402) 352-2204
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 47076749200 | Medicaid | NE |
Other providers in Schuyler, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.