Provider Demographics
NPI:1124362942
Name:RODRIGUEZ, VANIELY (DMD)
Entity Type:Individual
Prefix:
First Name:VANIELY
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE AGUAS BUENAS BUZON 1413 URB.LAS CASCADAS
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-3200
Mailing Address - Country:US
Mailing Address - Phone:787-528-4321
Mailing Address - Fax:
Practice Address - Street 1:STREET AGUAS BUENAS BUZON 1413
Practice Address - Street 2:URB. LAS CASCADAS
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-3200
Practice Address - Country:US
Practice Address - Phone:787-528-4321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2897122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist