Provider Demographics
NPI:1689600942
Name:RONCONE, TINOU T
Entity Type:Individual
Prefix:DR
First Name:TINOU
Middle Name:T
Last Name:RONCONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31493 RANCHO PUEBLO RD
Mailing Address - Street 2:STE. 101
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-4832
Mailing Address - Country:US
Mailing Address - Phone:951-302-6385
Mailing Address - Fax:
Practice Address - Street 1:32140 US HIGHWAY 79 S
Practice Address - Street 2:STE. 201
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-3899
Practice Address - Country:US
Practice Address - Phone:951-302-6385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA435671223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics