Provider Demographics
NPI:1639214661
Name:RODRIGUEZ, VICTOR (DDS)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16902 EL CAMINO REAL
Mailing Address - Street 2:SUITE 4B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2635
Mailing Address - Country:US
Mailing Address - Phone:281-280-9380
Mailing Address - Fax:
Practice Address - Street 1:16902 EL CAMINO REAL
Practice Address - Street 2:SUITE 4B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2635
Practice Address - Country:US
Practice Address - Phone:281-280-9380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX181491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice