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General NPI Number Information
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NPI Number | 1477769081
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Entity Type | Individual
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Provider Name | RODRIGO ADOLFO LAGOS D.D.S., M.S.
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Gender | Male
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 09/25/2014
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Provider Practice Location Address
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Address Line | 36945 COOK ST STE 101
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City | PALM DESERT
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State | CA
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Zip | 92211-6077
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Country | US
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Telephone | 760-568-3421
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Fax | 760-568-0731
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Provider Business Mailing Address
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Address Line | 36945 COOK ST STE 101
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City | PALM DESERT
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State | CA
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Zip | 92211-6077
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Country | US
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Telephone | 760-568-3421
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Fax | 760-568-0731
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 49570
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License Number State | CA
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