Provider Demographics
NPI:1396973301
Name:RODRIGUEZ, JORGELIN (DMD)
Entity type:Individual
Prefix:
First Name:JORGELIN
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8776 SW 12TH ST APT 206
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-3376
Mailing Address - Country:US
Mailing Address - Phone:786-252-3769
Mailing Address - Fax:
Practice Address - Street 1:1750 NE 167TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-3017
Practice Address - Country:US
Practice Address - Phone:305-949-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 17623122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist