Provider Demographics
NPI:1083780084
Name:DORA E RODRIGUEZ DMD PA
Entity Type:Organization
Organization Name:DORA E RODRIGUEZ DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORA
Authorized Official - Middle Name:E
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-431-3025
Mailing Address - Street 1:9449 SHERIDAN STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33024
Mailing Address - Country:US
Mailing Address - Phone:954-431-3025
Mailing Address - Fax:954-431-3201
Practice Address - Street 1:9449 SHERIDAN STREET
Practice Address - Street 2:SUITE B
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33024
Practice Address - Country:US
Practice Address - Phone:954-431-3025
Practice Address - Fax:954-431-3201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN168331223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL87192OtherBLUE CROSS BLUE SHIELD