Provider Demographics
NPI:1821833617
Name:RODRIGUEZ, ROBERTO JOSE (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:JOSE
Last Name:RODRIGUEZ
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 1:51 NE 46TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-1543
Mailing Address - Country:US
Mailing Address - Phone:813-493-2527
Mailing Address - Fax:
Practice Address - Street 1:5130 LINTON BLVD STE E3
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6595
Practice Address - Country:US
Practice Address - Phone:561-763-5943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN29181122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist