Provider Demographics
NPI:1174960199
Name:RODRIGUEZ, OCTAVIO RENE (DDS)
Entity type:Individual
Prefix:DR
First Name:OCTAVIO
Middle Name:RENE
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 JONES FERRY RD
Mailing Address - Street 2:APARTMENT: JJ05
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-2106
Mailing Address - Country:US
Mailing Address - Phone:828-674-1784
Mailing Address - Fax:
Practice Address - Street 1:105 NEWSOM ST
Practice Address - Street 2:SUITE 103
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2197
Practice Address - Country:US
Practice Address - Phone:919-797-2689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC95301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice