Provider Demographics
NPI:1023077229
Name:KELLEY-RONDERO, GEORGENE TERESE (DDS)
Entity type:Individual
Prefix:DR
First Name:GEORGENE
Middle Name:TERESE
Last Name:KELLEY-RONDERO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 NORTH IMPERIAL AVENUE, STE 204
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92251
Mailing Address - Country:US
Mailing Address - Phone:760-353-7670
Mailing Address - Fax:760-353-1722
Practice Address - Street 1:1503 NORTH IMPERIAL AVENUE, STE 204
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92251
Practice Address - Country:US
Practice Address - Phone:760-353-7670
Practice Address - Fax:760-353-1722
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42166122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist