Provider Demographics
NPI:1386407047
Name:LAMPE RODRIGUEZ, MERLLORY (DMD)
Entity type:Individual
Prefix:DR
First Name:MERLLORY
Middle Name:
Last Name:LAMPE 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 1:12386 STATE ROAD 535 # 236
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-6701
Mailing Address - Country:US
Mailing Address - Phone:321-337-5189
Mailing Address - Fax:
Practice Address - Street 1:5845 WINTER GARDEN VINELAND RD
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-6124
Practice Address - Country:US
Practice Address - Phone:407-258-3156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN296661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program