Provider Demographics
NPI:1407919657
Name:RODRIGUEZ, ENRIQUE JOSE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:JOSE
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:ENRIQUE
Other - Middle Name:JOSE
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 9020010
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00902-0010
Mailing Address - Country:US
Mailing Address - Phone:787-782-1946
Mailing Address - Fax:
Practice Address - Street 1:M-73 SANTA JUANITA AVE
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-798-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11721223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics