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General NPI Number Information
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NPI Number | 1932570462
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Entity Type | Organization
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Legal Business Name | DENTAL PM PC
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Dates
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Enumeration Date | 10/09/2015
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Last Update Date | 07/20/2023
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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 | 201-737-7283
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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 | 201-737-7283
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. RAFAEL D RODRIGUEZ
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Credential | DDS
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Telephone | 201-737-7283
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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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