Basic Information
| Provider Information | |||||||||
| NPI: | 1831195064 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AYMAT RODRIQUEZ | ||||||||
| FirstName: | WANDA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | VIAS PASEO SOL #40 | ||||||||
| Address2: | 200 BLVD DE LA FUENTE | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009265988 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878553996 | ||||||||
| FaxNumber: | 7878554346 | ||||||||
| Practice Location | |||||||||
| Address1: | BETANCES 38B | ||||||||
| Address2: | |||||||||
| City: | VEGA BAJA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006934308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878553996 | ||||||||
| FaxNumber: | 7878554346 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223E0200X | 2306 | PR | Y | Dental Providers | Dentist | Endodontics |
No ID Information.