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General NPI Number Information
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NPI Number | 1124398813
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Entity Type | Individual
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Provider Name | RODLIN JEROME D.D.S
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Gender | Male
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Dates
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Enumeration Date | 01/11/2012
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Last Update Date | 01/11/2012
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Provider Practice Location Address
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Address Line | 10728 NW 2ND AVE
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City | MIAMI SHORES
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State | FL
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Zip | 33168-4301
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Country | US
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Telephone | 786-285-5257
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Fax |
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Provider Business Mailing Address
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Address Line | 10728 NW 2ND AVE
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City | MIAMI SHORES
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State | FL
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Zip | 33168-4301
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Country | US
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Telephone | 786-285-5257
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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 | 19632
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License Number State | FL
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