Provider Demographics
NPI:1588830624
Name:FJR DENTAL OFFICE PC
Entity Type:Organization
Organization Name:FJR DENTAL OFFICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:J
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-561-0773
Mailing Address - Street 1:2951 GRAND CONCOURSE APT 6
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-1431
Mailing Address - Country:US
Mailing Address - Phone:718-561-0773
Mailing Address - Fax:718-561-4714
Practice Address - Street 1:2951 GRAND CONCOURSE APT 6
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-1431
Practice Address - Country:US
Practice Address - Phone:718-561-0773
Practice Address - Fax:718-561-4714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0461731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty