Provider Demographics
NPI:1720264492
Name:RODRIGUEZ, OSMAR
Entity Type:Individual
Prefix:DR
First Name:OSMAR
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:OSMAR
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:300 S MCLEAN BLVD STE M
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-1023
Mailing Address - Country:US
Mailing Address - Phone:847-531-5250
Mailing Address - Fax:847-531-5270
Practice Address - Street 1:300 S MCLEAN BLVD STE M
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-1023
Practice Address - Country:US
Practice Address - Phone:847-531-5250
Practice Address - Fax:847-531-5270
Is Sole Proprietor?:No
Enumeration Date:2008-01-12
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-025096122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist