Provider Demographics
NPI:1174521843
Name:ROD, EDWARD F JR (DDS)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:F
Last Name:ROD
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:2929 CALDER ST
Mailing Address - Street 2:#302
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1845
Mailing Address - Country:US
Mailing Address - Phone:409-832-2532
Mailing Address - Fax:
Practice Address - Street 1:2929 CALDER ST
Practice Address - Street 2:#302
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1845
Practice Address - Country:US
Practice Address - Phone:409-832-2532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123821223P0106X, 1223S0112X, 1223X0008X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
No1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery