Provider Demographics
NPI:1700570785
Name:RODRIGUEZ, PAOLA MARIE (DMD)
Entity Type:Individual
Prefix:
First Name:PAOLA
Middle Name:MARIE
Last Name:RODRIGUEZ
Suffix:
Gender:F
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:BRONXCARE HEALTH SYSTEMS DEPT OF DENTISTRY
Mailing Address - Street 2:1775 GRAND CONCOURSE 6TH FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453
Mailing Address - Country:US
Mailing Address - Phone:718-901-8410
Mailing Address - Fax:
Practice Address - Street 1:BRONXCARE HEALTH SYSTEMS DEPT OF DENTISTRY
Practice Address - Street 2:1775 GRAND CONCOURSE 6TH FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453
Practice Address - Country:US
Practice Address - Phone:718-901-8410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program