Provider Demographics
NPI:1811043193
Name:RODRIGUEZ, ALEX JAMES (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:JAMES
Last Name:RODRIGUEZ
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 1:245 N HIGHLAND AVE NE
Mailing Address - Street 2:SUITE 260
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-1936
Mailing Address - Country:US
Mailing Address - Phone:404-589-7799
Mailing Address - Fax:404-214-9414
Practice Address - Street 1:245 N HIGHLAND AVE NE
Practice Address - Street 2:SUITE 260
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307-1936
Practice Address - Country:US
Practice Address - Phone:404-589-7799
Practice Address - Fax:404-214-9414
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA130281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice