Provider Demographics
NPI:1316234149
Name:MCBRIDE, RODERICK LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:RODERICK
Middle Name:LEE
Last Name:MCBRIDE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:RICK
Other - Middle Name:L
Other - Last Name:MCBRIDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:890 SUNSET DR
Mailing Address - Street 2:B-1A
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-5651
Mailing Address - Country:US
Mailing Address - Phone:831-636-9808
Mailing Address - Fax:831-636-9843
Practice Address - Street 1:890 SUNSET DR
Practice Address - Street 2:B-1A
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-5651
Practice Address - Country:US
Practice Address - Phone:831-636-9808
Practice Address - Fax:831-636-9843
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314971223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery