Healthcare Provider Details

I. General information

NPI: 1548568736
Provider Name (Legal Business Name): NILKA RODRIGUEZ DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2011
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3233 S JOHN YOUNG PKWY
KISSIMMEE FL
34746-6543
US

IV. Provider business mailing address

600 TECHNOLOGY PARK
LAKE MARY FL
32746-7122
US

V. Phone/Fax

Practice location:
  • Phone: 407-933-1226
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN25823
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: