Provider Demographics
NPI:1144364456
Name:P. HIRAM RODRIGUEZ, DDS, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:P. HIRAM RODRIGUEZ, DDS, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:HIRAM
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-324-4893
Mailing Address - Street 1:4450 CALIFORNIA AVE STE J
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-1196
Mailing Address - Country:US
Mailing Address - Phone:661-324-4893
Mailing Address - Fax:
Practice Address - Street 1:4450 CALIFORNIA AVE STE J
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-1196
Practice Address - Country:US
Practice Address - Phone:661-324-4893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31113122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty