Basic Information
| Provider Information | |||||||||
| NPI: | 1003362559 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RODRIGUEZTAPIA | ||||||||
| FirstName: | ANGEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | TAPIA | ||||||||
| OtherFirstName: | ANGEL | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | MR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 398 192ND ARMOR TANK BATTALION RD | ||||||||
| Address2: | USA DENTAC HQS BLDG 1022 | ||||||||
| City: | FORT KNOX | ||||||||
| State: | KY | ||||||||
| PostalCode: | 401215116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026246158 | ||||||||
| FaxNumber: | 5026242966 | ||||||||
| Practice Location | |||||||||
| Address1: | 962 1ST INFANTRY DIVISION RD | ||||||||
| Address2: | JORDAN DENTAL CLINIC BLDG 2724 | ||||||||
| City: | FORT KNOX | ||||||||
| State: | KY | ||||||||
| PostalCode: | 401215210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026268301 | ||||||||
| FaxNumber: | 5026268300 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2016 | ||||||||
| LastUpdateDate: | 08/25/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 126800000X | Y | Dental Providers | Dental Assistant |
No ID Information.