Provider Demographics
NPI:1720662208
Name:RONDEROS, ANNA MARIE
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:MARIE
Last Name:RONDEROS
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:PO BOX 706
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35146-0706
Mailing Address - Country:US
Mailing Address - Phone:205-467-6147
Mailing Address - Fax:205-467-2933
Practice Address - Street 1:420 WALKER DR
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:AL
Practice Address - Zip Code:35146-3250
Practice Address - Country:US
Practice Address - Phone:205-467-2324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-10
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDRPM2342122300000X
390200000X
ALD-0007024-C1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty