Provider Demographics
NPI:1104177344
Name:DINA HARRIS-RODRIGUEZ, D.M.D., P.A.
Entity type:Organization
Organization Name:DINA HARRIS-RODRIGUEZ, D.M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-722-9339
Mailing Address - Street 1:7797 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-6110
Mailing Address - Country:US
Mailing Address - Phone:954-722-9339
Mailing Address - Fax:954-722-7399
Practice Address - Street 1:7797 N UNIVERSITY DR
Practice Address - Street 2:SUITE 201
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-6110
Practice Address - Country:US
Practice Address - Phone:954-722-9339
Practice Address - Fax:954-722-7399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN179921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty