Provider Demographics
NPI:1073825832
Name:RODRIGUEZ, ALAN JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:RODRIGUEZ
Suffix:JR
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 1:204 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-4822
Mailing Address - Country:US
Mailing Address - Phone:361-396-0370
Mailing Address - Fax:361-664-2248
Practice Address - Street 1:700 FLOURNOY RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4003
Practice Address - Country:US
Practice Address - Phone:361-664-1417
Practice Address - Fax:361-664-3218
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25698122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1649265646OtherNPI BRYAN CHC
TX1821185299OtherBVCAA AGENCY NPI
TX1275620551OtherROBERTSON CHC NPI
TX154467801Medicaid
TX154467803Medicaid
TX25698OtherSDBE DENTAL LICENSE
TX154467803Medicaid
TX1821185299OtherBVCAA AGENCY NPI