Provider Demographics
NPI:1316315401
Name:RODRIGUE, DOUGLAS JR (DDS)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:RODRIGUE
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1137 ESPLANADE AVE
Mailing Address - Street 2:APT 403
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70116-2084
Mailing Address - Country:US
Mailing Address - Phone:504-919-5904
Mailing Address - Fax:
Practice Address - Street 1:418 GIROD ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130-3626
Practice Address - Country:US
Practice Address - Phone:504-325-5777
Practice Address - Fax:504-827-1390
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-08
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA66031223D0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223D0001XDental ProvidersDentistDental Public Health