Provider Demographics
NPI:1649380072
Name:RODRIGUEZ, RAYMOND MICHAEL (DMD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:MICHAEL
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 1:5157 LAKE CREEK CT
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035
Mailing Address - Country:US
Mailing Address - Phone:972-987-7076
Mailing Address - Fax:
Practice Address - Street 1:6009 BELTLINE RD
Practice Address - Street 2:SUITE 224
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254
Practice Address - Country:US
Practice Address - Phone:972-934-8255
Practice Address - Fax:972-934-8262
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22039TX1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics