Provider Demographics
NPI:1679689152
Name:RODRIGUEZ, ANDRES HUMBERTO (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:HUMBERTO
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5101 VERNON AVENUE
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436
Mailing Address - Country:US
Mailing Address - Phone:952-920-9579
Mailing Address - Fax:952-920-9298
Practice Address - Street 1:5101 VERNON AVENUE
Practice Address - Street 2:SUITE 1B
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55436
Practice Address - Country:US
Practice Address - Phone:952-920-9579
Practice Address - Fax:952-920-9298
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNFF301223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics