Provider Demographics
NPI:1639463045
Name:RODRIGUEZ, MICHAEL EDWARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EDWARD
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 DEL PRADO BLVD S
Mailing Address - Street 2:SUITE D,E
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-3692
Mailing Address - Country:US
Mailing Address - Phone:239-573-2323
Mailing Address - Fax:239-574-8595
Practice Address - Street 1:1127 DEL PRADO BLVD S
Practice Address - Street 2:SUITE D,E
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3692
Practice Address - Country:US
Practice Address - Phone:239-573-2323
Practice Address - Fax:239-574-8595
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21114122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist