Provider Demographics
NPI:1487675054
Name:RODRIGUEZ, JORDI XAVIER (DMD)
Entity Type:Individual
Prefix:DR
First Name:JORDI
Middle Name:XAVIER
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6610 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-4034
Mailing Address - Country:US
Mailing Address - Phone:954-720-8752
Mailing Address - Fax:
Practice Address - Street 1:6610 N UNIVERSITY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-4034
Practice Address - Country:US
Practice Address - Phone:954-720-8752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL129501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice