Provider Demographics
NPI:1861186371
Name:RODRIGUEZ, JUAN L (DDS)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:L
Last Name:RODRIGUEZ
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 1:19400 E 57TH AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80019-2911
Mailing Address - Country:US
Mailing Address - Phone:719-930-9666
Mailing Address - Fax:
Practice Address - Street 1:160 E CHEYENNE RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-2524
Practice Address - Country:US
Practice Address - Phone:719-249-8775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00205585122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist