Healthcare Provider Details

I. General information

NPI: 1770510133
Provider Name (Legal Business Name): EDUARDO E RODES D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 09/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 CALLE DR RAMON E BETANCES N SUITE 201
MAYAGUEZ PR
00680-6659
US

IV. Provider business mailing address

60 CALLE DR RAMON E BETANCES N SUITE 201
MAYAGUEZ PR
00680-6659
US

V. Phone/Fax

Practice location:
  • Phone: 787-265-1972
  • Fax:
Mailing address:
  • Phone: 787-265-1972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2135
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: