Provider Demographics
NPI:1619864311
Name:DENTISTRY OF PLYMOUTH SORRENTO
Entity type:Organization
Organization Name:DENTISTRY OF PLYMOUTH SORRENTO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THAYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-337-9191
Mailing Address - Street 1:3585 GRETCHEN DR
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-0029
Mailing Address - Country:US
Mailing Address - Phone:321-337-9191
Mailing Address - Fax:
Practice Address - Street 1:2050 PLYMOUTH SORRENTO RD STE 200
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-5699
Practice Address - Country:US
Practice Address - Phone:407-553-6995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty