Provider Demographics
NPI:1033128889
Name:RODRIGUEZ, LUS ANGEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:LUS
Middle Name:ANGEL
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 AVE UNIV INTERAMERICANA
Mailing Address - Street 2:SUITE 4 LA QUINTA SHOPPING COURT
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-4308
Mailing Address - Country:US
Mailing Address - Phone:787-892-1102
Mailing Address - Fax:787-892-1102
Practice Address - Street 1:175 AVE UNIV INTERAMERICANA
Practice Address - Street 2:SUITE 4 LA QUINTA SHOPPING COURT
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-4308
Practice Address - Country:US
Practice Address - Phone:787-892-1102
Practice Address - Fax:787-892-1102
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice