Provider Demographics
NPI:1366412223
Name:CITRO, RONNIE MARK (DDS)
Entity type:Individual
Prefix:DR
First Name:RONNIE
Middle Name:MARK
Last Name:CITRO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:RON
Other - Middle Name:MARK
Other - Last Name:CITRO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:175 W 93RD ST
Mailing Address - Street 2:APT 14B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-9313
Mailing Address - Country:US
Mailing Address - Phone:401-835-5940
Mailing Address - Fax:
Practice Address - Street 1:USS GEORGE WASHINGTON
Practice Address - Street 2:BOX 66
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96650-2801
Practice Address - Country:US
Practice Address - Phone:301-295-0145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010431122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist