Provider Demographics
NPI:1144356338
Name:KLINKOWIZE, RONALD JOHN (DMD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JOHN
Last Name:KLINKOWIZE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 PARLEY RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-1227
Mailing Address - Country:US
Mailing Address - Phone:203-431-0994
Mailing Address - Fax:203-431-0918
Practice Address - Street 1:15 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-1351
Practice Address - Country:US
Practice Address - Phone:203-268-2600
Practice Address - Fax:203-459-1969
Is Sole Proprietor?:No
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0420071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice