Provider Demographics
NPI:1851335004
Name:RODRIGUEZ, JOSE' RAFAEL (DDS)
Entity Type:Individual
Prefix:
First Name:JOSE'
Middle Name:RAFAEL
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 WORNALL RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-5941
Mailing Address - Country:US
Mailing Address - Phone:816-561-4555
Mailing Address - Fax:816-561-3574
Practice Address - Street 1:4320 WORNALL RD
Practice Address - Street 2:SUITE 500
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-5941
Practice Address - Country:US
Practice Address - Phone:816-561-4555
Practice Address - Fax:816-561-3574
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0149731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice