Provider Demographics
NPI:1457851800
Name:RONDHUIS, EELCO DIEDERIK (DMD)
Entity Type:Individual
Prefix:
First Name:EELCO
Middle Name:DIEDERIK
Last Name:RONDHUIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WHITTIER PL STE 110
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-1408
Mailing Address - Country:US
Mailing Address - Phone:617-742-6868
Mailing Address - Fax:
Practice Address - Street 1:7 WHITTIER PL STE 110
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-1408
Practice Address - Country:US
Practice Address - Phone:617-742-6868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-12
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20050122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty