Provider Demographics
NPI:1639944648
Name:GUIMARAES, RODOLPHO LUVISON COSTA (DDS)
Entity Type:Individual
Prefix:MR
First Name:RODOLPHO
Middle Name:LUVISON COSTA
Last Name:GUIMARAES
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 1:4071 LEE ROAD SUITE 210
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128
Mailing Address - Country:US
Mailing Address - Phone:216-727-0124
Mailing Address - Fax:
Practice Address - Street 1:5969 BROAD STREET SUITE 303
Practice Address - Street 2:SUITE 303
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213
Practice Address - Country:US
Practice Address - Phone:614-626-8822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNO.RES.0046961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice