Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 3211 | PR |
Y | 1223P0221X | Pediatric Dentist | DN23920 | FL |
NPI | 1093154460 |
---|---|
Provider Name | Miss Glenda L. Rodriguez Aguiar |
First Address | Orlando, FL 32809-4977 |
Second Address | Orlando, FL 32809-4977 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2013 |
Last Update Date | 05/03/2019 |