Provider Demographics
NPI:1295980944
Name:RODRIGUEZ FARRACH, RENE ALEJANDRO (DMD)
Entity type:Individual
Prefix:DR
First Name:RENE
Middle Name:ALEJANDRO
Last Name:RODRIGUEZ FARRACH
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 1:11682 SOUTHWEST FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77031-3612
Mailing Address - Country:US
Mailing Address - Phone:832-457-4051
Mailing Address - Fax:
Practice Address - Street 1:11682 SOUTHWEST FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77031-3612
Practice Address - Country:US
Practice Address - Phone:832-457-4051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-21
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0377041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX26467OtherTEXAS STATE BOARD OF DENTAL EXAMINERS
PADS037704OtherPENNSYLVANIA STATE BOARD OF DENTISTRY