Individual
IVELISS RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
12801 W SUNRISE BLVD # F222, SUNRISE, FL 33323-4020
(954) 846-7171
Mailing address
1830 SABAL PALM DR APT 405, DAVIE, FL 33324-5938
(786) 357-6000
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DN23099
FL
1223P0300X
Periodontics
Primary
DN23099
FL
Other
Enumeration date
11/15/2018
Last updated
07/07/2020
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