Provider Demographics
NPI:1306662978
Name:RODRIGUEZ, ESMERLYN (RDH)
Entity type:Individual
Prefix:
First Name:ESMERLYN
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 N 11TH ST
Mailing Address - Street 2:
Mailing Address - City:PROSPECT PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-2102
Mailing Address - Country:US
Mailing Address - Phone:973-930-2937
Mailing Address - Fax:
Practice Address - Street 1:242 KEARNY AVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-2505
Practice Address - Country:US
Practice Address - Phone:973-955-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-28
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22H101271200124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist