Healthcare Provider Details

I. General information

NPI: 1366418402
Provider Name (Legal Business Name): ROBERTO JOSE RODIL D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8118 CALLE CONCORDIA GALERIA PROFESIONAL SUITE 204
PONCE PR
00717-1562
US

IV. Provider business mailing address

8118 CALLE CONCORDIA GALERIA PROFESIONAL SUITE 204
PONCE PR
00717-1562
US

V. Phone/Fax

Practice location:
  • Phone: 787-840-0881
  • Fax:
Mailing address:
  • Phone: 787-840-0881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2457
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: