Provider Demographics
NPI:1053623223
Name:KELBIN RODRIGUEZ D.D.S., PLLC
Entity type:Organization
Organization Name:KELBIN RODRIGUEZ D.D.S., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KELBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-689-7556
Mailing Address - Street 1:512 MERCHANT DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37912-3851
Mailing Address - Country:US
Mailing Address - Phone:865-689-7556
Mailing Address - Fax:865-689-1067
Practice Address - Street 1:512 MERCHANT DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37912-3851
Practice Address - Country:US
Practice Address - Phone:865-689-7556
Practice Address - Fax:865-689-1067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-05
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN88201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty