Provider Demographics
NPI:1023141801
Name:RODMAN, RICHARD (DDS, PA)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:RODMAN
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 EASTMAN ST
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-2108
Mailing Address - Country:US
Mailing Address - Phone:908-276-2447
Mailing Address - Fax:908-276-2467
Practice Address - Street 1:15 EASTMAN ST
Practice Address - Street 2:
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-2108
Practice Address - Country:US
Practice Address - Phone:908-276-2447
Practice Address - Fax:908-276-2467
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 147181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice