Provider Demographics
NPI:1710104724
Name:PEDRO E RODRIGUEZ
Entity Type:Organization
Organization Name:PEDRO E RODRIGUEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:E
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PA
Authorized Official - Phone:305-625-9411
Mailing Address - Street 1:4629 NW 199 STREET
Mailing Address - Street 2:
Mailing Address - City:MIAMIGARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055
Mailing Address - Country:US
Mailing Address - Phone:305-625-9411
Mailing Address - Fax:305-625-9410
Practice Address - Street 1:4629 NW 199TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-1508
Practice Address - Country:US
Practice Address - Phone:305-625-9411
Practice Address - Fax:305-625-9410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00127811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty