Provider Demographics
NPI:1073771580
Name:RODRIGUES, VINICIUS SOUZA (DDS, DMSC)
Entity Type:Individual
Prefix:
First Name:VINICIUS
Middle Name:SOUZA
Last Name:RODRIGUES
Suffix:
Gender:M
Credentials:DDS, DMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:697 BARTON DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-1144
Mailing Address - Country:US
Mailing Address - Phone:603-943-2188
Mailing Address - Fax:
Practice Address - Street 1:9018 N SKYVIEW AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64154-8501
Practice Address - Country:US
Practice Address - Phone:816-741-5113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS619881223P0300X
MO20220127341223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics