Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 6159362-9922 | UT |
N | 1223D0001X | Dental Public Health | 6159362-9922 | UT |
N | 1223G0001X | General Practice | 6159362-9922 | UT |
N | 213EG0000X | General Practice | 6159362-9922 | UT |
NPI | 1265929640 |
---|---|
Provider Name | Daniel Rodriguez |
First Address | South Jordan, UT 84095-8214 |
Second Address | Salt Lake City, UT 84111-3846 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2018 |
Last Update Date | 12/09/2020 |