Provider Demographics
NPI:1942513122
Name:RODRIGUEZ, RENE E (DMD)
Entity Type:Individual
Prefix:DR
First Name:RENE
Middle Name:E
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 1:765 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4553
Mailing Address - Country:US
Mailing Address - Phone:305-883-4880
Mailing Address - Fax:
Practice Address - Street 1:1201 E PONCE DE LEON BLVD
Practice Address - Street 2:#203
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-3344
Practice Address - Country:US
Practice Address - Phone:305-343-7312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2020-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN191071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice