Provider Demographics
NPI:1639298235
Name:RODRIGUEZ, FERNAN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:FERNAN
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:DDS, MS
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Other - Middle Name:
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Mailing Address - Street 1:325 W WESTCHESTER PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-2857
Mailing Address - Country:US
Mailing Address - Phone:972-263-1755
Mailing Address - Fax:972-264-6226
Practice Address - Street 1:325 W WESTCHESTER PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-2857
Practice Address - Country:US
Practice Address - Phone:972-263-1755
Practice Address - Fax:972-264-6226
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2015-11-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX216071223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics