Provider Demographics
NPI:1497565881
Name:JORDAN RODRIGUEZ D.D.S APC
Entity type:Organization
Organization Name:JORDAN RODRIGUEZ D.D.S APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-995-7481
Mailing Address - Street 1:13325 MAIN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-9111
Mailing Address - Country:US
Mailing Address - Phone:760-995-9144
Mailing Address - Fax:
Practice Address - Street 1:13325 MAIN ST STE 104
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-9111
Practice Address - Country:US
Practice Address - Phone:760-995-9144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-09
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty