Healthcare Provider Details

I. General information

NPI: 1841925757
Provider Name (Legal Business Name): ADRIAN BLANCO RODRIGUEZ DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2022
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6170 GUNN HWY
TAMPA FL
33625-4014
US

IV. Provider business mailing address

812 BAMA RD
BRANDON FL
33511-6906
US

V. Phone/Fax

Practice location:
  • Phone: 786-572-8245
  • Fax:
Mailing address:
  • Phone: 786-572-8245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH29950
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN31647
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: