Healthcare Provider Details

I. General information

NPI: 1710811807
Provider Name (Legal Business Name): SUMTER VALUE DENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 E BELT AVE
BUSHNELL FL
33513-5208
US

IV. Provider business mailing address

410 E BELT AVE
BUSHNELL FL
33513-5208
US

V. Phone/Fax

Practice location:
  • Phone: 352-569-4962
  • Fax:
Mailing address:
  • Phone: 352-569-4962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. CARLOS RODRIGUEZ
Title or Position: OWNER
Credential: DDS
Phone: 305-733-2600