Provider Demographics
NPI:1740204205
Name:RODRIGUEZ-ESPADA, ANGEL L (DMD)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:L
Last Name:RODRIGUEZ-ESPADA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8020 OCEAN DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-1895
Mailing Address - Country:US
Mailing Address - Phone:214-767-3921
Mailing Address - Fax:214-767-3923
Practice Address - Street 1:10651 E ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78419-5130
Practice Address - Country:US
Practice Address - Phone:361-961-4311
Practice Address - Fax:361-961-2529
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX175121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice