Healthcare Provider Details

I. General information

NPI: 1932602182
Provider Name (Legal Business Name): CARLOS MANUEL RODRIGUEZ III D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2018
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 CR 542W
BUSHNELL FL
33513-4515
US

IV. Provider business mailing address

18216 SANDY POINTE DR
TAMPA FL
33647-3328
US

V. Phone/Fax

Practice location:
  • Phone: 352-569-0100
  • Fax:
Mailing address:
  • Phone: 305-733-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN23484
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: