Provider Demographics
NPI:1942098561
Name:AVERY, RONDA J (RDH, LMT)
Entity type:Individual
Prefix:
First Name:RONDA
Middle Name:J
Last Name:AVERY
Suffix:
Gender:F
Credentials:RDH, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:ME
Mailing Address - Zip Code:04917-3823
Mailing Address - Country:US
Mailing Address - Phone:860-609-2253
Mailing Address - Fax:
Practice Address - Street 1:303 KIMBALL POND RD
Practice Address - Street 2:
Practice Address - City:NEW SHARON
Practice Address - State:ME
Practice Address - Zip Code:04955-3703
Practice Address - Country:US
Practice Address - Phone:207-500-0454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT5996225700000X
MERDH4146124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist