Provider Demographics
NPI:1710220447
Name:RODLIN JEROME DDS PA
Entity Type:Organization
Organization Name:RODLIN JEROME DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RODLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JEROME
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-704-8977
Mailing Address - Street 1:20823 NW 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-2103
Mailing Address - Country:US
Mailing Address - Phone:305-704-8977
Mailing Address - Fax:
Practice Address - Street 1:20823 NW 2ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-2103
Practice Address - Country:US
Practice Address - Phone:305-704-8977
Practice Address - Fax:305-704-8984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-01
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19632122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty