Provider Demographics
NPI:1063751501
Name:RODMO DENTAL LLC
Entity type:Organization
Organization Name:RODMO DENTAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NOHORA
Authorized Official - Middle Name:INES
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-581-7555
Mailing Address - Street 1:4229 N PINE ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6047
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:954-749-7557
Practice Address - Street 1:4229 N PINE ISLAND RD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6047
Practice Address - Country:US
Practice Address - Phone:954-581-7555
Practice Address - Fax:954-749-7557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty