Healthcare Provider Details

I. General information

NPI: 1356917215
Provider Name (Legal Business Name): GABRIEL RODRIGUEZ DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6839 COLLIER BLVD
NAPLES FL
34114-3632
US

IV. Provider business mailing address

3979 HARVEST CT
NAPLES FL
34112-6205
US

V. Phone/Fax

Practice location:
  • Phone: 239-206-1659
  • Fax:
Mailing address:
  • Phone: 786-975-6281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN26471
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: