Provider Demographics
NPI:1528572666
Name:ELDOR, RODNEL JEAN
Entity Type:Individual
Prefix:
First Name:RODNEL JEAN
Middle Name:
Last Name:ELDOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:US ARMY DENTAL HEALTH ACTIVITY
Mailing Address - Street 2:BLD 128, CHAFFEE RD
Mailing Address - City:FORT BLISS
Mailing Address - State:TX
Mailing Address - Zip Code:79916
Mailing Address - Country:US
Mailing Address - Phone:915-742-6001
Mailing Address - Fax:
Practice Address - Street 1:US ARMY DENTAL HEALTH ACTIVITY
Practice Address - Street 2:BLD 128, CHAFFEE RD
Practice Address - City:FORT BLISS
Practice Address - State:TX
Practice Address - Zip Code:79916
Practice Address - Country:US
Practice Address - Phone:915-742-6001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant