Provider Demographics
NPI:1619489937
Name:SHIRO, RONDA MARIE (STERILIZATION TECH)
Entity Type:Individual
Prefix:MS
First Name:RONDA
Middle Name:MARIE
Last Name:SHIRO
Suffix:
Gender:F
Credentials:STERILIZATION TECH
Other - Prefix:MS
Other - First Name:RONDA
Other - Middle Name:MARIE
Other - Last Name:HOLLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:171 INNER LOOP RPAD
Mailing Address - Street 2:
Mailing Address - City:FORT IRWIN
Mailing Address - State:CA
Mailing Address - Zip Code:92310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:171 INNER LOOP RPAD
Practice Address - Street 2:
Practice Address - City:FORT IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92310
Practice Address - Country:US
Practice Address - Phone:719-526-5537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant