Provider Demographics
NPI:1831195064
Name:AYMAT RODRIQUEZ, WANDA M (DMD)
Entity type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:M
Last Name:AYMAT RODRIQUEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:VIAS PASEO SOL #40
Mailing Address - Street 2:200 BLVD DE LA FUENTE
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5988
Mailing Address - Country:US
Mailing Address - Phone:787-855-3996
Mailing Address - Fax:787-855-4346
Practice Address - Street 1:BETANCES 38B
Practice Address - Street 2:
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693-4308
Practice Address - Country:US
Practice Address - Phone:787-855-3996
Practice Address - Fax:787-855-4346
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR23061223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics