Provider Demographics
NPI:1679675946
Name:DEMARCO, RODRIGO
Entity Type:Individual
Prefix:
First Name:RODRIGO
Middle Name:
Last Name:DEMARCO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 TUSKAWILLA RD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-5204
Mailing Address - Country:US
Mailing Address - Phone:407-699-0958
Mailing Address - Fax:
Practice Address - Street 1:1450 TUSKAWILLA RD
Practice Address - Street 2:SUITE 116
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-5204
Practice Address - Country:US
Practice Address - Phone:407-699-0958
Practice Address - Fax:407-699-7812
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN169491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice