Provider Demographics
NPI:1770630865
Name:RODRIGUEZ MELENDEZ, AMILCAR RAFAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMILCAR
Middle Name:RAFAEL
Last Name:RODRIGUEZ MELENDEZ
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 1:15038 CALLE UCAR
Mailing Address - Street 2:URB PASEOS DE JACARANDA
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757
Mailing Address - Country:US
Mailing Address - Phone:787-608-7779
Mailing Address - Fax:787-812-3153
Practice Address - Street 1:GLENVIEW GARDENS SHOPPING CENTER
Practice Address - Street 2:SUITE #4
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00731
Practice Address - Country:US
Practice Address - Phone:787-812-3173
Practice Address - Fax:787-812-3153
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR26681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice