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General NPI Number Information
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NPI Number | 1063583292
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Entity Type | Individual
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Provider Name | LESTER MANUEL RODRIGUEZ RDH, DDS
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Gender | Male
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Dates
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Enumeration Date | 11/10/2006
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 1845 HOLSONBACK DR
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-5282
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Country | US
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Telephone | 386-274-0500
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Fax |
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Provider Business Mailing Address
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Address Line | 1016 S PALMETTO AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-6164
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Country | US
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Telephone | 626-975-2743
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 49650
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 15381
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License Number State | FL
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