Provider Demographics
NPI:1780255711
Name:JUAN C RODRIGUEZ DMD
Entity type:Organization
Organization Name:JUAN C RODRIGUEZ DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-768-3607
Mailing Address - Street 1:5341 LIMEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33472-1247
Mailing Address - Country:US
Mailing Address - Phone:561-768-3607
Mailing Address - Fax:
Practice Address - Street 1:25195 CHAMBER OF COMMERCE DR # 16
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-7895
Practice Address - Country:US
Practice Address - Phone:561-768-3607
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental