Healthcare Provider Details

I. General information

NPI: 1750070314
Provider Name (Legal Business Name): RODRIGO FERNANDEZ RANGEL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 HARVARD ST
BROOKLINE MA
02445-7904
US

IV. Provider business mailing address

136 BABCOCK ST APT 214
BROOKLINE MA
02446-5975
US

V. Phone/Fax

Practice location:
  • Phone: 617-738-0806
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDN1859910
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: