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General NPI Number Information
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NPI Number | 1336351964
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Entity Type | Individual
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Provider Name | RAFAEL D RODRIGUEZ DDS
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Gender | Male
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 04/12/2021
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Provider Practice Location Address
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Address Line | 175 MARKET ST 3RD FLOOR
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City | PATERSON
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State | NJ
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Zip | 07505-1728
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Country | US
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Telephone | 347-554-9137
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Fax |
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Provider Business Mailing Address
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Address Line | 4532 KENNEDY BLVD
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City | UNION CITY
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State | NJ
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Zip | 07087-2707
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Country | US
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Telephone | 347-554-9137
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02512900
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License Number State | NJ
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