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General NPI Number Information
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NPI Number | 1255400966
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Entity Type | Individual
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Provider Name | DEIDRA RONDENO DDS
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Gender | Female
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 52 EXECUTIVE PARK SOUTH NE STE 5203
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City | ATLANTA
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State | GA
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Zip | 30329-2217
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Country | US
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Telephone | 404-942-0086
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Fax | 208-955-2434
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Provider Business Mailing Address
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Address Line | 52 EXECUTIVE PARK SOUTH NE STE 5203
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City | ATLANTA
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State | GA
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Zip | 30329-2217
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Country | US
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Telephone | 404-942-0086
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Fax | 208-955-2434
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN011717
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License Number State | GA
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