Provider Demographics
NPI:1346346939
Name:RONDON, OBDULIA DOLORES (DMD)
Entity Type:Individual
Prefix:
First Name:OBDULIA
Middle Name:DOLORES
Last Name:RONDON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7030 NORMANDY BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-6206
Mailing Address - Country:US
Mailing Address - Phone:904-613-3375
Mailing Address - Fax:
Practice Address - Street 1:7030 NORMANDY BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-6206
Practice Address - Country:US
Practice Address - Phone:904-786-5850
Practice Address - Fax:904-786-3101
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN164351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL075633400Medicaid