Provider Demographics
NPI:1508052184
Name:RODIG, RAY RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAY
Middle Name:RICHARD
Last Name:RODIG
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 1:2937 VENEMAN AVE STE A201
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-0681
Mailing Address - Country:US
Mailing Address - Phone:209-524-5044
Mailing Address - Fax:209-524-5064
Practice Address - Street 1:2937 VENEMAN AVE STE A201
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-0681
Practice Address - Country:US
Practice Address - Phone:209-524-5044
Practice Address - Fax:209-524-5064
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA318511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice