Provider Demographics
NPI:1215390216
Name:RODRIGUEZ, NOEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:NOEL
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
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:NAVAL BRANCH HEALTH CLINIC NAS JAX
Mailing Address - Street 2:P.O. BOX 8 BLDG 964
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32214-0001
Mailing Address - Country:US
Mailing Address - Phone:904-546-7199
Mailing Address - Fax:
Practice Address - Street 1:NAVAL BRANCH HEALTH CLINIC NAS JAX
Practice Address - Street 2:BLDG 9 64, BIRMINGHAM AVE.
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32214-0001
Practice Address - Country:US
Practice Address - Phone:904-546-7199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX256721223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics