Provider Demographics
NPI:1205897345
Name:RODRICK, DAVID L (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:RODRICK
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 1:6979 S HOLLY CIR
Mailing Address - Street 2:SUITE 235
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-1577
Mailing Address - Country:US
Mailing Address - Phone:303-793-0793
Mailing Address - Fax:303-488-9756
Practice Address - Street 1:6979 S HOLLY CIR
Practice Address - Street 2:SUITE 235
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-1577
Practice Address - Country:US
Practice Address - Phone:303-793-0793
Practice Address - Fax:303-488-9756
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1056801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice