Provider Demographics
NPI:1942608773
Name:SHAYNA RONDON DDS INC
Entity Type:Organization
Organization Name:SHAYNA RONDON DDS INC
Other - Org Name:PERIODONTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:RONDON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:925-449-6633
Mailing Address - Street 1:1171 MURRIETA BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4143
Mailing Address - Country:US
Mailing Address - Phone:925-449-6633
Mailing Address - Fax:925-449-0766
Practice Address - Street 1:1171 MURRIETA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4143
Practice Address - Country:US
Practice Address - Phone:925-449-6633
Practice Address - Fax:925-449-0766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-10
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA592921223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty