Provider Demographics
NPI:1760407795
Name:RODRIGUEZ, RUTH (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:654 AVE MUNOZ RIVERA
Mailing Address - Street 2:SUITE 1104
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-4123
Mailing Address - Country:US
Mailing Address - Phone:787-764-1414
Mailing Address - Fax:787-763-3885
Practice Address - Street 1:654 AVE MUNOZ RIVERA
Practice Address - Street 2:SUITE 1104
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4123
Practice Address - Country:US
Practice Address - Phone:787-764-1414
Practice Address - Fax:787-763-3885
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23251223G0001X
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice