Provider Demographics
NPI:1548273063
Name:BALDO, RONALD FRANK (DDS)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:FRANK
Last Name:BALDO
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 1:36464 MONROE CRAWFORD RD
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:LA
Mailing Address - Zip Code:70452-4212
Mailing Address - Country:US
Mailing Address - Phone:985-863-3336
Mailing Address - Fax:
Practice Address - Street 1:66240 HIGHWAY 41 SPUR
Practice Address - Street 2:SUITE B
Practice Address - City:PEARL RIVER
Practice Address - State:LA
Practice Address - Zip Code:70452-5749
Practice Address - Country:US
Practice Address - Phone:985-863-6740
Practice Address - Fax:985-863-0047
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA41471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1841471Medicaid