Provider Demographics
NPI:1669736690
Name:RONDON, SHAYNA (DDS)
Entity type:Individual
Prefix:
First Name:SHAYNA
Middle Name:
Last Name:RONDON
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 1:6934 ARMOUR CIR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880-3626
Mailing Address - Country:US
Mailing Address - Phone:909-362-1251
Mailing Address - Fax:
Practice Address - Street 1:1171 MURRIETA BLVD
Practice Address - Street 2:
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
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA592921223P0300X
CADDS592921223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223P0300XDental ProvidersDentistPeriodontics