Provider Demographics
NPI:1093154460
Name:RODRIGUEZ AGUIAR, GLENDA L (DMD)
Entity type:Individual
Prefix:MISS
First Name:GLENDA
Middle Name:L
Last Name:RODRIGUEZ AGUIAR
Suffix:
Gender:F
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:HC 1 BOX 9354
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-9769
Mailing Address - Country:US
Mailing Address - Phone:787-604-0343
Mailing Address - Fax:
Practice Address - Street 1:MANATI MEDICAL PLAZA
Practice Address - Street 2:1 CALLE JOSE CANDELAS SUITE 208
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-5527
Practice Address - Country:US
Practice Address - Phone:787-854-6478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR32111223P0221X, 122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN23920OtherFLORIDA