Provider Demographics
NPI:1871517045
Name:O'BOYLE, RONALD CHARLES (DMD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:CHARLES
Last Name:O'BOYLE
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 1:4 FORK ST
Mailing Address - Street 2:SUITE 3040
Mailing Address - City:MOUNT POCONO
Mailing Address - State:PA
Mailing Address - Zip Code:18344-1200
Mailing Address - Country:US
Mailing Address - Phone:570-839-8065
Mailing Address - Fax:570-839-8649
Practice Address - Street 1:4 FORK ST
Practice Address - Street 2:SUITE 3040
Practice Address - City:MOUNT POCONO
Practice Address - State:PA
Practice Address - Zip Code:18344-1200
Practice Address - Country:US
Practice Address - Phone:570-839-8065
Practice Address - Fax:570-839-8649
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018292L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice