=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619304144
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR DENTISTRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2013
-----------------------------------------------------
Last Update Date | 02/02/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14750 SW 26TH ST SUITE # 210
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33185-5933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-498-8092
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14750 SW 26TH ST SUITE # 210
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33185-5933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | C.O.O
-----------------------------------------------------
Name | DR. RAMON ANTONIO RODRIGUEZ JR.
-----------------------------------------------------
Credential | D.M. D.
-----------------------------------------------------
Telephone | 305-498-8092
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DN18940
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------