Healthcare Provider Details

I. General information

NPI: 1225245236
Provider Name (Legal Business Name): BETTY MARGARITA RONDON-TRINIDAD DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 05/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 NORTH ST
MIDDLETOWN NY
10940-5012
US

IV. Provider business mailing address

2570 ROUTE 9W STE 10
CORNWALL NY
12518-1370
US

V. Phone/Fax

Practice location:
  • Phone: 845-342-3900
  • Fax: 845-342-1813
Mailing address:
  • Phone: 845-220-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number041426
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: