Provider Demographics
NPI:1679616577
Name:OLMOS, RODOLFO ANDREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:ANDREW
Last Name:OLMOS
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 1:9753 S ORANGE BLOSSOM TRL
Mailing Address - Street 2:STE 105
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-8998
Mailing Address - Country:US
Mailing Address - Phone:407-857-8585
Mailing Address - Fax:
Practice Address - Street 1:9753 S ORANGE BLOSSOM TRL STE 105
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-8998
Practice Address - Country:US
Practice Address - Phone:407-857-8585
Practice Address - Fax:407-857-8448
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN165861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice