Provider Demographics
NPI:1023198397
Name:RODRIGUEZ, LUIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:
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 1:1874 SW 138TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-7500
Mailing Address - Country:US
Mailing Address - Phone:305-553-4779
Mailing Address - Fax:
Practice Address - Street 1:11 N ROYAL POINCIANA BLVD
Practice Address - Street 2:SUITE #200
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-4423
Practice Address - Country:US
Practice Address - Phone:305-884-2751
Practice Address - Fax:305-884-6119
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN120541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice