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General NPI Number Information
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NPI Number | 1710409990
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Entity Type | Individual
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Provider Name | CAMILO RODRIGUEZ DMD
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Gender | Male
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Dates
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Enumeration Date | 07/10/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 7593 W BOYNTON BEACH BLVD STE 200
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City | BOYNTON BEACH
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State | FL
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Zip | 33437-6162
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Country | US
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Telephone | 561-732-3203
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Fax |
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Provider Business Mailing Address
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Address Line | 13866 SW 102ND TER
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City | MIAMI
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State | FL
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Zip | 33186-7301
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Country | US
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Telephone | 305-338-2941
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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 | 22852
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License Number State | FL
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