Provider Demographics
NPI:1689782435
Name:ACOSTA-ORTIZ, RODOLFO (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:
Last Name:ACOSTA-ORTIZ
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 HAMMONDVILLE RD
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-1989
Mailing Address - Country:US
Mailing Address - Phone:954-972-6066
Mailing Address - Fax:954-935-3138
Practice Address - Street 1:1711 HAMMONDVILLE RD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-1989
Practice Address - Country:US
Practice Address - Phone:954-972-6450
Practice Address - Fax:954-972-7028
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16118122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL070559401Medicaid