Provider Demographics
NPI:1043887201
Name:RODRIGUEZ NOALLA, RODOLFO FRANCISCO (DMD)
Entity Type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:FRANCISCO
Last Name:RODRIGUEZ NOALLA
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 1:1732 BROADWAY UNIT 402
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2414
Mailing Address - Country:US
Mailing Address - Phone:395-335-6406
Mailing Address - Fax:
Practice Address - Street 1:1732 BROADWAY UNIT 402
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-2414
Practice Address - Country:US
Practice Address - Phone:395-335-6406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61180844122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist