Provider Demographics
NPI:1720299407
Name:GAUTHIER, RODULFO A (DMD)
Entity Type:Individual
Prefix:DR
First Name:RODULFO
Middle Name:A
Last Name:GAUTHIER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2044 CALLE JORGE MANRRIQUE
Mailing Address - Street 2:EL SENORIAL
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6925
Mailing Address - Country:US
Mailing Address - Phone:787-761-3173
Mailing Address - Fax:
Practice Address - Street 1:2044 CALLE JORGE MANRRIQUE
Practice Address - Street 2:EL SENORIAL
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6925
Practice Address - Country:US
Practice Address - Phone:787-761-3173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice