Healthcare Provider Details

I. General information

NPI: 1497433411
Provider Name (Legal Business Name): RODRIGO ANDRES ARIAS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 NW FEDERAL HWY STE A110
STUART FL
34994-9314
US

IV. Provider business mailing address

175 SW SEA LION RD
PORT SAINT LUCIE FL
34953-5457
US

V. Phone/Fax

Practice location:
  • Phone: 772-692-4002
  • Fax:
Mailing address:
  • Phone: 772-224-6276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN28176
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: