Healthcare Provider Details

I. General information

NPI: 1902995095
Provider Name (Legal Business Name): JOSEPH VINCENT RONDEROS SR. D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 WALKER DR
SPRINGVILLE AL
35146-3250
US

IV. Provider business mailing address

PO BOX 706 420 WALKER DR
SPRINGVILLE AL
35146-0706
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4254
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: