Provider Demographics
NPI:1356583652
Name:BARBOSA, RODOLFO D
Entity type:Individual
Prefix:
First Name:RODOLFO
Middle Name:D
Last Name:BARBOSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9059 EPNORTH AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-4043
Mailing Address - Country:US
Mailing Address - Phone:702-271-0410
Mailing Address - Fax:
Practice Address - Street 1:526 S TONOPAH DR
Practice Address - Street 2:#200
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4043
Practice Address - Country:US
Practice Address - Phone:702-271-0410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV57101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice