Provider Demographics
NPI:1720372675
Name:TYRONE F. RODRIGUEZ, D.D.S., P.L.L.C.
Entity Type:Organization
Organization Name:TYRONE F. RODRIGUEZ, D.D.S., P.L.L.C.
Other - Org Name:SMILESONRISAS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TYRONE
Authorized Official - Middle Name:F
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-766-9030
Mailing Address - Street 1:825 SHARON AVE E
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-2441
Mailing Address - Country:US
Mailing Address - Phone:509-766-9030
Mailing Address - Fax:509-766-5624
Practice Address - Street 1:825 SHARON AVE E
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-2441
Practice Address - Country:US
Practice Address - Phone:509-766-9030
Practice Address - Fax:509-766-5624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010610122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty