Provider Demographics
NPI:1144329897
Name:RODEN, RICK J (DDS)
Entity type:Individual
Prefix:DR
First Name:RICK
Middle Name:J
Last Name:RODEN
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 1:129 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:HEREFORD
Mailing Address - State:TX
Mailing Address - Zip Code:79045-5202
Mailing Address - Country:US
Mailing Address - Phone:806-364-2213
Mailing Address - Fax:806-364-1091
Practice Address - Street 1:129 W 5TH ST
Practice Address - Street 2:
Practice Address - City:HEREFORD
Practice Address - State:TX
Practice Address - Zip Code:79045-5202
Practice Address - Country:US
Practice Address - Phone:806-364-2213
Practice Address - Fax:806-364-1091
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX156641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice