Provider Demographics
NPI:1417394339
Name:RODRIGUEZ-TORRES, RANDALL RAMON (DMD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:RAMON
Last Name:RODRIGUEZ-TORRES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:RANDALL
Other - Middle Name:RAMON
Other - Last Name:RODRIGUEZ-TORRES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:5580 NW 107TH AVE APT 1203
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-4931
Mailing Address - Country:US
Mailing Address - Phone:772-370-3246
Mailing Address - Fax:
Practice Address - Street 1:5231 UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PARK
Practice Address - State:FL
Practice Address - Zip Code:34201-3009
Practice Address - Country:US
Practice Address - Phone:941-363-0458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-01
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 20396122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist