Healthcare Provider Details

I. General information

NPI: 1043052061
Provider Name (Legal Business Name): ANDREA S RODRIGUEZ ROLON DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 AVENIDA HOSTOS EDIFICIO GO GOGO FOUNDATION
PONCE PR
00780
US

IV. Provider business mailing address

305 CALLE 20
GUAYNABO PR
00969-4451
US

V. Phone/Fax

Practice location:
  • Phone: 939-422-2142
  • Fax:
Mailing address:
  • Phone: 787-466-7289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number3564
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number3564
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: