Provider Demographics
NPI:1316621626
Name:RODRIGUEZ, STEPHANY DIANE (DMD)
Entity type:Individual
Prefix:
First Name:STEPHANY
Middle Name:DIANE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 NE 191ST ST APT 309
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4257
Mailing Address - Country:US
Mailing Address - Phone:786-716-6053
Mailing Address - Fax:
Practice Address - Street 1:1750 NE 191ST ST APT 309
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-4257
Practice Address - Country:US
Practice Address - Phone:786-716-6053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN279291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice