Provider Demographics
NPI:1083098875
Name:RODRIGUEZ, ODET (RDH)
Entity Type:Individual
Prefix:
First Name:ODET
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51560 AVENIDA VELASCO
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-3171
Mailing Address - Country:US
Mailing Address - Phone:760-673-8259
Mailing Address - Fax:
Practice Address - Street 1:51560 AVENIDA VELASCO
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-3171
Practice Address - Country:US
Practice Address - Phone:760-673-8259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-12
Last Update Date:2015-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29053124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist