Provider Demographics
NPI:1386336568
Name:RODRIGUEZ FERNANDEZ, ALCI SR
Entity type:Individual
Prefix:
First Name:ALCI
Middle Name:
Last Name:RODRIGUEZ FERNANDEZ
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SYMPHONY RD
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-4053
Mailing Address - Country:US
Mailing Address - Phone:857-241-7762
Mailing Address - Fax:
Practice Address - Street 1:63 COURT ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02108-2109
Practice Address - Country:US
Practice Address - Phone:617-997-4225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1859879122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist