Provider Demographics
NPI:1013366434
Name:RODRIGUEZ, CHRISTOPHER MICHAEL (DDS)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 EXECUTIVE PL STE A
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-4260
Mailing Address - Country:US
Mailing Address - Phone:479-250-1516
Mailing Address - Fax:479-225-9220
Practice Address - Street 1:1521 EXECUTIVE PL STE A
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-4260
Practice Address - Country:US
Practice Address - Phone:479-250-1516
Practice Address - Fax:479-225-9220
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR40981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice