Healthcare Provider Details

I. General information

NPI: 1114101433
Provider Name (Legal Business Name): CARLOS J RODRIGUEZ-FEO, DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 12/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 SW 80TH ST STE 125
MIAMI FL
33143-4661
US

IV. Provider business mailing address

6601 SW 80TH ST STE 125
MIAMI FL
33143-4661
US

V. Phone/Fax

Practice location:
  • Phone: 305-665-3721
  • Fax: 305-665-3602
Mailing address:
  • Phone: 305-665-3721
  • Fax: 305-665-3602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN11350
License Number StateFL

VIII. Authorized Official

Name: DR. CARLOS J RODRIGUEZ-FEO
Title or Position: PRESIDENT
Credential: DDS
Phone: 305-665-3721