Provider Demographics
NPI:1033108253
Name:RODRIGUEZ, CARLOS SERGIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:SERGIO
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 1:1301 MEDICAL PARK CIR
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:TN
Mailing Address - Zip Code:38261-5877
Mailing Address - Country:US
Mailing Address - Phone:731-885-0355
Mailing Address - Fax:731-885-8224
Practice Address - Street 1:1301 MEDICAL PARK CIR
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-5877
Practice Address - Country:US
Practice Address - Phone:731-885-0355
Practice Address - Fax:731-885-8224
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7217122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist