Provider Demographics
NPI:1326192915
Name:RODRIGUEZ, JORGE L (DMD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:L
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:D3 CALLE JASPE
Mailing Address - Street 2:ESTANCIAS DE YAUCO
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-2837
Mailing Address - Country:US
Mailing Address - Phone:787-856-8794
Mailing Address - Fax:787-856-8794
Practice Address - Street 1:10 CALLE DR PASARELL
Practice Address - Street 2:
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-3657
Practice Address - Country:US
Practice Address - Phone:787-267-5222
Practice Address - Fax:787-267-8941
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice