Provider Demographics
NPI:1679741698
Name:PUTZLER, RONALD CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:CHARLES
Last Name:PUTZLER
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 1:1940 W GALENA BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-4319
Mailing Address - Country:US
Mailing Address - Phone:630-892-8794
Mailing Address - Fax:
Practice Address - Street 1:1940 W GALENA BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-4319
Practice Address - Country:US
Practice Address - Phone:630-892-8794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190186571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice