Provider Demographics
NPI:1114101433
Name:CARLOS J RODRIGUEZ-FEO, DDS PA
Entity Type:Organization
Organization Name:CARLOS J RODRIGUEZ-FEO, DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:J
Authorized Official - Last Name:RODRIGUEZ-FEO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-665-3721
Mailing Address - Street 1:6601 SW 80TH ST STE 125
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4661
Mailing Address - Country:US
Mailing Address - Phone:305-665-3721
Mailing Address - Fax:305-665-3602
Practice Address - Street 1:6601 SW 80TH ST
Practice Address - Street 2:STE 125
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4661
Practice Address - Country:US
Practice Address - Phone:305-665-3721
Practice Address - Fax:305-665-3602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN113501223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL63504-85OtherMEDICARE
FLVO9444Medicare UPIN