Individual
DR. TYRONE FERNANDO RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
825 SHARON AVE E, MOSES LAKE, WA 98837-2441
(509) 766-9030
Mailing address
825 E SHARON AVE, MOSES LAKE, WA 98837
(509) 766-9030
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
21889
TX
1223P0221X
Pediatric Dentistry
Primary
DE00010610
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0212066
L & I
WA
01
—
5051248
CHPW
WA
05
—
5051248
—
WA
01
—
911019392
COMMERCIAL
—
Enumeration date
01/26/2007
Last updated
02/29/2012
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