Provider Demographics
NPI:1013956168
Name:RODRIGUEZ, NELSON SR (DMD)
Entity Type:Individual
Prefix:DR
First Name:NELSON
Middle Name:
Last Name:RODRIGUEZ
Suffix:SR
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:NELSON
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:68 CALLE SANTA CRUZ
Mailing Address - Street 2:TORRE SAN PABLO SUITE 702
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-7031
Mailing Address - Country:US
Mailing Address - Phone:787-780-2048
Mailing Address - Fax:787-780-2226
Practice Address - Street 1:68 CALLE SANTA CRUZ
Practice Address - Street 2:TORRE SAN PABLO SUITE 702
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7031
Practice Address - Country:US
Practice Address - Phone:787-780-2048
Practice Address - Fax:787-780-2226
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR24581223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRU91802Medicare UPIN