Provider Demographics
NPI:1467425926
Name:RODRIGUEZ, JOSE CARLOS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:CARLOS
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6606 150TH LN
Mailing Address - Street 2:
Mailing Address - City:GORDON
Mailing Address - State:NE
Mailing Address - Zip Code:69343-5407
Mailing Address - Country:US
Mailing Address - Phone:308-282-0779
Mailing Address - Fax:
Practice Address - Street 1:EAST HIGHWAY 18
Practice Address - Street 2:
Practice Address - City:PINE RIDGE
Practice Address - State:SD
Practice Address - Zip Code:57770-1201
Practice Address - Country:US
Practice Address - Phone:605-867-3078
Practice Address - Fax:605-867-3229
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0018711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice