Healthcare Provider Details

I. General information

NPI: 1407919657
Provider Name (Legal Business Name): ENRIQUE JOSE RODRIGUEZ D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ENRIQUE JOSE RODRIGUEZ D.M.D.

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

M-73 SANTA JUANITA AVE
BAYAMON PR
00956
US

IV. Provider business mailing address

PO BOX 9020010
SAN JUAN PR
00902-0010
US

V. Phone/Fax

Practice location:
  • Phone: 787-798-9700
  • Fax:
Mailing address:
  • Phone: 787-782-1946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number1172
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: