Provider Demographics
NPI:1174919732
Name:LAGUNA RODRIGUEZ, JESSICA M (DMD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:LAGUNA RODRIGUEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:CALLE EIDER #701
Mailing Address - Street 2:LOS ALMENDROS PLAZA-1 APT.910
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924
Mailing Address - Country:US
Mailing Address - Phone:787-667-1161
Mailing Address - Fax:
Practice Address - Street 1:PLAZA DEL CARMEN MALL
Practice Address - Street 2:PR 172 INT PR 1 SUITE 22
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:917-860-1807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR32771223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry