Healthcare Provider Details

I. General information

NPI: 1053268870
Provider Name (Legal Business Name): SEBASTIAN RODRIGUEZ DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2026
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 OLD FURNACE RD
BOILING SPRINGS SC
29316-8591
US

IV. Provider business mailing address

201 OLD BOILING SPRINGS RD
GREER SC
29650-4227
US

V. Phone/Fax

Practice location:
  • Phone: 864-592-1647
  • Fax:
Mailing address:
  • Phone: 864-561-7545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11149
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: