Provider Demographics
NPI:1730405804
Name:RAKECKY, RONALD WALTER (DDS)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:WALTER
Last Name:RAKECKY
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 1:7 MILLRACE CT
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-2614
Mailing Address - Country:US
Mailing Address - Phone:313-271-0697
Mailing Address - Fax:
Practice Address - Street 1:7 MILLRACE CT
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-2614
Practice Address - Country:US
Practice Address - Phone:313-929-5360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901008418122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist