Provider Demographics
NPI:1942812730
Name:WILFREDO RODRIGUEZ DMD PA
Entity Type:Organization
Organization Name:WILFREDO RODRIGUEZ DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:407-275-5844
Mailing Address - Street 1:201 S SEMORAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-3288
Mailing Address - Country:US
Mailing Address - Phone:407-275-5844
Mailing Address - Fax:407-658-6551
Practice Address - Street 1:201 S SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3288
Practice Address - Country:US
Practice Address - Phone:407-275-5844
Practice Address - Fax:407-658-6551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies