MEDICARE: CAMILO RODRIGUEZ DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	22852	FL

General Provider Information

NPI Number	:	1710409990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMILO RODRIGUEZ DMD

Provider Business Mailing Address
First Line	:	13866 SW 102ND TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-7301
Country	:	US
Telephone Number	:	305-338-2941
Fax Number	:

Provider Business Practice Location Address
First Line	:	7593 W BOYNTON BEACH BLVD STE 200
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-6162
Country	:	US
Telephone Number	:	561-732-3203
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2017
Last Update Date	:	03/17/2018

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