Provider Demographics
NPI:1447429733
Name:RODRIGUEZ, JORGE ANDRES (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:ANDRES
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 BOYLSTON ST
Mailing Address - Street 2:SIXTH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-3304
Mailing Address - Country:US
Mailing Address - Phone:617-262-1422
Mailing Address - Fax:617-262-1424
Practice Address - Street 1:359 BOYLSTON ST
Practice Address - Street 2:SIXTH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-3304
Practice Address - Country:US
Practice Address - Phone:617-262-1422
Practice Address - Fax:617-262-1424
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA186741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice