Provider Demographics
NPI:1487262853
Name:RODRIGUES, ALLAN (DDS)
Entity type:Individual
Prefix:
First Name:ALLAN
Middle Name:
Last Name:RODRIGUES
Suffix:
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 1:3585 GRETCHEN DR
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-0029
Mailing Address - Country:US
Mailing Address - Phone:321-337-8008
Mailing Address - Fax:
Practice Address - Street 1:1603 S HIAWASSEE RD STE 135
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-6439
Practice Address - Country:US
Practice Address - Phone:407-293-8324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN25237122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist