Provider Demographics
NPI:1356309686
Name:RODRIGUEZ, RICARDO SR (DMD)
Entity Type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:
Last Name:RODRIGUEZ
Suffix:SR
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:BOX 675
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705
Mailing Address - Country:US
Mailing Address - Phone:787-735-4172
Mailing Address - Fax:787-735-9234
Practice Address - Street 1:EDIFICIO GUAYACAN CALLE JOSE C VASQUEZ #202
Practice Address - Street 2:SUITE 111
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705
Practice Address - Country:US
Practice Address - Phone:787-735-4172
Practice Address - Fax:787-735-9234
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1885122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist