Provider Demographics
NPI:1386035251
Name:SANDRA RODRIGUEZ DDS INC
Entity Type:Organization
Organization Name:SANDRA RODRIGUEZ DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-916-8922
Mailing Address - Street 1:20025 LAKE FOREST DR STE 105
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-8716
Mailing Address - Country:US
Mailing Address - Phone:949-916-8922
Mailing Address - Fax:949-916-8911
Practice Address - Street 1:20025 LAKE FOREST DR STE 105
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-8716
Practice Address - Country:US
Practice Address - Phone:949-916-8922
Practice Address - Fax:949-916-8911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-12
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty