Healthcare Provider Details

I. General information

NPI: 1124422738
Provider Name (Legal Business Name): RODRIGUEZ DENTAL, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2014
Last Update Date: 10/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SUNNY ISLES BLVD STE 9
SUNNY ISLES BEACH FL
33160-4398
US

IV. Provider business mailing address

200 SUNNY ISLES BLVD STE 9
SUNNY ISLES BEACH FL
33160-4398
US

V. Phone/Fax

Practice location:
  • Phone: 786-382-7249
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number StateFL

VIII. Authorized Official

Name: FRANCISCO RODRIGUEZ
Title or Position: PRESIDENT
Credential:
Phone: 786-629-1503