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General NPI Number Information
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NPI Number | 1790318152
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Entity Type | Individual
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Provider Name | KEVIN MANUEL RODRIGUEZ-LICHTENBERG DDS, MPH
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Gender | Male
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Dates
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Enumeration Date | 02/13/2020
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Last Update Date | 09/19/2024
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Provider Practice Location Address
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Address Line | 1150 45TH ST
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City | WEST PALM BEACH
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State | FL
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Zip | 33407-2361
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Country | US
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Telephone | 561-642-1000
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Fax | 561-804-5629
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Provider Business Mailing Address
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Address Line | 1515 N FLAGLER DR STE 101
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-3429
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Country | US
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Telephone | 561-642-1000
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Fax | 561-804-5629
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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 | 0401417104
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 17358
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License Number State | MD
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