Active NPI
Octavio Rene Rodriguez, DDS
- General Practice Dentistry
- Durham, NC
National Provider Identifier
1174960199
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 9530
- Practice address
- 105 Newsom St
Suite 103
Durham, NC 27704-2197 - Phone
- (919) 797-2689
- NPI assigned
- May 31, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 9530 | NC | Primary |
Addresses
Primary practice location
105 Newsom St
Suite 103
Durham, NC 27704-2197
Mailing address
605 Jones Ferry Rd
Apartment: JJ05
Carrboro, NC 27510-2106
Phone (828) 674-1784
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9530 | NC | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| William Jae Lee, DDS III, PA | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dentist
- Durham, NC
- NPI 1841661006
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1369958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1369958400000",
"number": "1174960199",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "605 JONES FERRY RD",
"address_2": "APARTMENT: JJ05",
"city": "CARRBORO",
"state": "NC",
"postal_code": "275102106",
"telephone_number": "828-674-1784"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 NEWSOM ST",
"address_2": "SUITE 103",
"city": "DURHAM",
"state": "NC",
"postal_code": "277042197",
"telephone_number": "919-797-2689"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RODRIGUEZ",
"first_name": "OCTAVIO",
"middle_name": "RENE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-05-31",
"last_updated": "2013-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NC",
"license": "9530",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Durham, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.