Provider Demographics
NPI:1730169293
Name:RODRIGUEZ, CARLA DAMARIS (DMD)
Entity type:Individual
Prefix:DR
First Name:CARLA
Middle Name:DAMARIS
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. RIVER GARDEN 137 FLOR DE MAR
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-3350
Mailing Address - Country:US
Mailing Address - Phone:787-638-6328
Mailing Address - Fax:787-761-8425
Practice Address - Street 1:124 CALLE ARZUAGA
Practice Address - Street 2:
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00925-3302
Practice Address - Country:US
Practice Address - Phone:787-765-7915
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR26661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice