Provider Demographics
NPI:1912015645
Name:RODRIGUEZ, MARIO R (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:R
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:URB. TORRIMAR
Mailing Address - Street 2:1 SEVILLA ST.
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966
Mailing Address - Country:US
Mailing Address - Phone:787-316-6886
Mailing Address - Fax:787-774-1022
Practice Address - Street 1:URB. TORRIMAR
Practice Address - Street 2:1 CALLE SEVILLA
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966
Practice Address - Country:US
Practice Address - Phone:787-316-6886
Practice Address - Fax:787-774-1022
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice