Provider Demographics
NPI:1447538913
Name:RODRIGUEZ, JOSEPH LAWRENCE (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:LAWRENCE
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:GREENBERG DENTAL & ORTHODONTICS
Mailing Address - Street 2:949 NORTH 14TH STEET
Mailing Address - City:LEESBERG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-0001
Mailing Address - Country:US
Mailing Address - Phone:352-460-0164
Mailing Address - Fax:
Practice Address - Street 1:GREENBERG DENTAL & ORTHODONTICS
Practice Address - Street 2:949 NORTH 14TH STEET
Practice Address - City:LEESBERG
Practice Address - State:FL
Practice Address - Zip Code:34748-0001
Practice Address - Country:US
Practice Address - Phone:524-600-1643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 60227736122300000X
NC9646122300000X
FL217961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1447538913Medicaid