Active NPI
Eduardo Manuel Rodriguez, D.D.S.
- Dentist
- Cape Coral, FL
National Provider Identifier
1205986445
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN24096
- Practice address
- 316 Del Prado Blvd S
Cape Coral, FL 33990-1710 - Phone
- (239) 278-3600
- NPI assigned
- Jan 11, 2007
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | DN24096 | FL | Primary |
Addresses
Primary practice location
316 Del Prado Blvd S
Cape Coral, FL 33990-1710
Mailing address
PO Box 919771
Orlando, FL 32891-9771
Phone (239) 278-3600
Other practice location 1
Font Martello Ave.
#344
Humacao, PR 00791
Phone (787) 850-8099
Other practice location 2
503 Muir St Ste A
Cambridge, MD 21613-1848
Phone (410) 228-4045
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 105177900 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200123000417 | FL | Order and Referring Only - Dentist | 9931429115 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN24096 | FL | MD | Dentist |
Networks
- Freedom Health HMO Network
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1601424000000",
"number": "1205986445",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 919771",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328919771",
"telephone_number": "239-278-3600",
"fax_number": "239-226-4650"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "316 DEL PRADO BLVD S",
"city": "CAPE CORAL",
"state": "FL",
"postal_code": "339901710",
"telephone_number": "239-278-3600"
}
],
"practiceLocations": [
{
"address_1": "Font Martello Ave.",
"address_2": "#344",
"address_purpose": "LOCATION",
"city": "Humacao",
"state": "PR",
"postal_code": "00791",
"country_code": "US",
"telephone_number": "787-850-8099",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "503 Muir St Ste A",
"address_purpose": "LOCATION",
"city": "Cambridge",
"state": "MD",
"postal_code": "216131848",
"country_code": "US",
"telephone_number": "410-228-4045",
"fax_number": "410-228-9384",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "RODRIGUEZ",
"first_name": "EDUARDO",
"middle_name": "MANUEL",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-11",
"last_updated": "2020-09-30",
"certification_date": "2020-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "DN24096",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "105177900",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cape Coral, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.