Provider Demographics
NPI:1023125879
Name:JUPITER, RONALD M (DDS)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:M
Last Name:JUPITER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 EYLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876-1501
Mailing Address - Country:US
Mailing Address - Phone:973-584-4361
Mailing Address - Fax:973-584-3518
Practice Address - Street 1:119 EYLAND AVENUE
Practice Address - Street 2:
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876-1501
Practice Address - Country:US
Practice Address - Phone:973-584-4361
Practice Address - Fax:973-584-3518
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ11127122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist