Provider Demographics
NPI:1366176810
Name:RODES, DIEGO
Entity type:Individual
Prefix:DR
First Name:DIEGO
Middle Name:
Last Name:RODES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3171
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-3171
Mailing Address - Country:US
Mailing Address - Phone:787-219-9032
Mailing Address - Fax:
Practice Address - Street 1:909 AVE TITO CASTRO STE 810
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4725
Practice Address - Country:US
Practice Address - Phone:787-219-9032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18595541223G0001X
PR0034691223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No1223G0001XDental ProvidersDentistGeneral Practice