MEDICARE: WILFREDO RODRIGUEZ DMD PA

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1942812730
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILFREDO RODRIGUEZ DMD PA

Provider Business Mailing Address
First Line	:	201 S SEMORAN BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32807-3288
Country	:	US
Telephone Number	:	407-275-5844
Fax Number	:	407-658-6551

Provider Business Practice Location Address
First Line	:	201 S SEMORAN BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32807-3288
Country	:	US
Telephone Number	:	407-275-5844
Fax Number	:	407-658-6551

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. WILFREDO RODRIGUEZ
Credential	:	DMD
Telephone Number	:	407-275-5844

Provider Enumeration Date	:	08/21/2020
Last Update Date	:	08/21/2020

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