Provider Demographics
NPI:1720467111
Name:RODRIGUEZ, ZACHARY LOUIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:LOUIS
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:ZACHARY
Other - Middle Name:LOUIS
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 860036
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55486-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:36050 DETROIT RD
Practice Address - Street 2:T AND U
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-1683
Practice Address - Country:US
Practice Address - Phone:510-209-5896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-19
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.024784122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist