Provider Demographics
NPI:1134661150
Name:JAMES MANUEL RODRIGUEZ DDS DENTAL CORP
Entity Type:Organization
Organization Name:JAMES MANUEL RODRIGUEZ DDS DENTAL CORP
Other - Org Name:PACIFIC WAVE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-229-8000
Mailing Address - Street 1:7676 JACKSON DR.
Mailing Address - Street 2:SUITE 8
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-1562
Mailing Address - Country:US
Mailing Address - Phone:619-229-8000
Mailing Address - Fax:619-324-4153
Practice Address - Street 1:7676 JACKSON DR.
Practice Address - Street 2:SUITE 8
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-1562
Practice Address - Country:US
Practice Address - Phone:619-229-8000
Practice Address - Fax:619-324-4153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-08
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty