Provider Demographics
NPI:1487397162
Name:RODRIGUEZ-APONTE, IAN MANUEL (DMD)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:MANUEL
Last Name:RODRIGUEZ-APONTE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 N WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-2040
Mailing Address - Country:US
Mailing Address - Phone:954-805-3452
Mailing Address - Fax:
Practice Address - Street 1:18900 W 10 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2669
Practice Address - Country:US
Practice Address - Phone:248-565-3332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2024-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016022751223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry