Provider Demographics
NPI:1063583292
Name:RODRIGUEZ, LESTER MANUEL (RDH, DDS)
Entity type:Individual
Prefix:
First Name:LESTER
Middle Name:MANUEL
Last Name:RODRIGUEZ
Suffix:
Gender:
Credentials:RDH, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 S PALMETTO AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-6164
Mailing Address - Country:US
Mailing Address - Phone:626-975-2743
Mailing Address - Fax:
Practice Address - Street 1:1845 HOLSONBACK DR
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5282
Practice Address - Country:US
Practice Address - Phone:386-274-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA496501223G0001X
FL15381124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG92760-02OtherDENTICAL
CAG92760-01OtherDENTICAL