Provider Demographics
NPI:1225118755
Name:RODRIGUEZ, ADRIAN IVAR (DMD,MSD)
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:IVAR
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:DMD,MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 NE 15TH ST
Mailing Address - Street 2:APT 29C
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-1451
Mailing Address - Country:US
Mailing Address - Phone:305-373-5807
Mailing Address - Fax:
Practice Address - Street 1:1001 IVES DAIRY RD
Practice Address - Street 2:SUITE 103
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-2501
Practice Address - Country:US
Practice Address - Phone:305-652-3412
Practice Address - Fax:305-652-3459
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN143681223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics