Provider Demographics
NPI:1710985304
Name:RODRIGUEZ, EDWIN OSCAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:OSCAR
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 CALLE BARCELO
Mailing Address - Street 2:
Mailing Address - City:BARRANQUITAS
Mailing Address - State:PR
Mailing Address - Zip Code:00794-1758
Mailing Address - Country:US
Mailing Address - Phone:787-857-5954
Mailing Address - Fax:787-857-2345
Practice Address - Street 1:68 CALLE BARCELO
Practice Address - Street 2:
Practice Address - City:BARRANQUITAS
Practice Address - State:PR
Practice Address - Zip Code:00794-1758
Practice Address - Country:US
Practice Address - Phone:787-857-5954
Practice Address - Fax:787-857-2345
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice