Healthcare Provider Details

I. General information

NPI: 1720662208
Provider Name (Legal Business Name): DR. ANNA MARIE RONDEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 01/16/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 WALKER DR
SPRINGVILLE AL
35146-3250
US

IV. Provider business mailing address

PO BOX 706
SPRINGVILLE AL
35146-0706
US

V. Phone/Fax

Practice location:
  • Phone: 205-467-2324
  • Fax:
Mailing address:
  • Phone: 205-467-6147
  • Fax: 205-467-2933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDRPM2342
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD-0007024-C1
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: