1396186649 NPI number — DR. RONALD EDWARD TRAPP DDS

Table of content: DR. RONALD EDWARD TRAPP DDS (NPI 1396186649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396186649 NPI number — DR. RONALD EDWARD TRAPP DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRAPP
Provider First Name:
RONALD
Provider Middle Name:
EDWARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TRAPP
Provider Other First Name:
SUE ELLEN
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1396186649
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4900 OAK ACRES LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33905-7320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-694-5918
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2470 EDISON AVE
Provider Second Line Business Practice Location Address:
PROJECT DENTISTS CARE OF SW FLORIDA
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-470-1302
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/16/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223D0001X , with the licence number:  DN20045 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)