Provider Demographics
NPI:1215634720
Name:ARIEL J. RODRIGUEZ DENTAL OFFICE OF REDONDO BEACH, INC
Entity type:Organization
Organization Name:ARIEL J. RODRIGUEZ DENTAL OFFICE OF REDONDO BEACH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ARIEL
Authorized Official - Middle Name:JULIAN
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-378-7494
Mailing Address - Street 1:1921 S. CATALINA AVE, SUITE #4
Mailing Address - Street 2:1921 S. CATALINA AVE, SUITE #4
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277
Mailing Address - Country:US
Mailing Address - Phone:310-378-7494
Mailing Address - Fax:
Practice Address - Street 1:1921 S. CATALINA AVE, SUITE #4
Practice Address - Street 2:1921 S. CATALINA AVE, SUITE #4
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277
Practice Address - Country:US
Practice Address - Phone:310-378-7494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental