Provider Demographics
NPI:1538682844
Name:RODRIGUEZ LANTIGUA, JOSE GREGORIO (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:GREGORIO
Last Name:RODRIGUEZ LANTIGUA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:G
Other - Last Name:RODRIGUEZ L
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1445 RIVER ROCK CT
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6545
Mailing Address - Country:US
Mailing Address - Phone:347-969-3885
Mailing Address - Fax:
Practice Address - Street 1:12780 WATERFORD LAKES PKWY STE 105
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-4501
Practice Address - Country:US
Practice Address - Phone:347-969-3885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN22925122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist