Provider Demographics
NPI:1740504299
Name:ESPERANZA A. RODRIGUEZ, DDS PC
Entity type:Organization
Organization Name:ESPERANZA A. RODRIGUEZ, DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ESPERANZA
Authorized Official - Middle Name:A
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-364-7791
Mailing Address - Street 1:2406 WALTON AVE
Mailing Address - Street 2:#SOB
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-6454
Mailing Address - Country:US
Mailing Address - Phone:718-364-7791
Mailing Address - Fax:718-364-4135
Practice Address - Street 1:2406 WALTON AVE
Practice Address - Street 2:#SOB
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-6454
Practice Address - Country:US
Practice Address - Phone:718-364-7791
Practice Address - Fax:718-364-4135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0503261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty