Provider Demographics
NPI:1720109085
Name:LEOPOLDO RODRIGUEZ DDS, LLC
Entity Type:Organization
Organization Name:LEOPOLDO RODRIGUEZ DDS, LLC
Other - Org Name:LEOPOLDO RODRIGUEZ DDS, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEOPOLDO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-596-3939
Mailing Address - Street 1:1304 N ACADEMY BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-3325
Mailing Address - Country:US
Mailing Address - Phone:719-596-3939
Mailing Address - Fax:719-573-9267
Practice Address - Street 1:1304 N ACADEMY BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-3325
Practice Address - Country:US
Practice Address - Phone:719-596-3939
Practice Address - Fax:719-573-9267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty