Provider Demographics
NPI:1477769081
Name:LAGOS, RODRIGO ADOLFO (DDS, MS)
Entity Type:Individual
Prefix:
First Name:RODRIGO
Middle Name:ADOLFO
Last Name:LAGOS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36945 COOK ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-6077
Mailing Address - Country:US
Mailing Address - Phone:760-568-3421
Mailing Address - Fax:760-568-0731
Practice Address - Street 1:36945 COOK ST STE 101
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-6077
Practice Address - Country:US
Practice Address - Phone:760-568-3421
Practice Address - Fax:760-568-0731
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA495701223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics