Provider Demographics
NPI:1356771224
Name:RODRIGUEZ, MIRILIS MIRIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:MIRILIS
Middle Name:MIRIAM
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:MIRILIS
Other - Middle Name:MIRIAM
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:11865 SW 26TH ST STEB-5
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-2471
Mailing Address - Country:US
Mailing Address - Phone:305-360-7002
Mailing Address - Fax:305-360-7009
Practice Address - Street 1:11865 SW 26TH ST STEB-5
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-2471
Practice Address - Country:US
Practice Address - Phone:305-360-7002
Practice Address - Fax:305-360-7009
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-13
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 203931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice