Provider Demographics
NPI:1699194092
Name:RODRIGUEZ, VICTOR (DDS, CAGS)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:DDS, CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 NW 87TH AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2657
Mailing Address - Country:US
Mailing Address - Phone:786-953-6550
Mailing Address - Fax:786-431-5918
Practice Address - Street 1:2000 NW 87TH AVE STE 215
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-2657
Practice Address - Country:US
Practice Address - Phone:786-953-6550
Practice Address - Fax:786-431-5918
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-14
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21843261QM1300X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty