Provider Demographics
NPI:1487964367
Name:RODRIGUEZ, RICARDO (DDS)
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:RODRIGUEZ
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 1:4521 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-2407
Mailing Address - Country:US
Mailing Address - Phone:323-261-4838
Mailing Address - Fax:323-261-5915
Practice Address - Street 1:4521 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-2407
Practice Address - Country:US
Practice Address - Phone:323-261-4838
Practice Address - Fax:323-267-5915
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-13
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA408801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice