Provider Demographics
NPI:1548485600
Name:RONALD D DAURIO DDS PC
Entity type:Organization
Organization Name:RONALD D DAURIO DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:DAURIO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-564-1102
Mailing Address - Street 1:4130 REDWOOD LN
Mailing Address - Street 2:SUITE 130
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-3295
Mailing Address - Country:US
Mailing Address - Phone:719-564-1102
Mailing Address - Fax:719-565-0234
Practice Address - Street 1:4130 REDWOOD LN
Practice Address - Street 2:SUITE 130
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-3295
Practice Address - Country:US
Practice Address - Phone:719-564-1102
Practice Address - Fax:719-565-0234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO79125531Medicaid