Provider Demographics
NPI:1255418232
Name:RODRIGUEZ, DANIEL E
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:E
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12A CALLE BUEN SAMARITANO
Mailing Address - Street 2:GARDENVILLE
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-7933
Mailing Address - Country:US
Mailing Address - Phone:787-783-0783
Mailing Address - Fax:787-783-1502
Practice Address - Street 1:12A CALLE BUEN SAMARITANO
Practice Address - Street 2:GARDENVILLE
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-7933
Practice Address - Country:US
Practice Address - Phone:787-783-0783
Practice Address - Fax:787-783-1502
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice