Provider Demographics
NPI:1427323229
Name:STEVEN J. RODRIGUEZ D.D.S. P.A.
Entity type:Organization
Organization Name:STEVEN J. RODRIGUEZ D.D.S. P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:VERNICE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-690-8844
Mailing Address - Street 1:PO BOX 11209
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76547-1209
Mailing Address - Country:US
Mailing Address - Phone:254-690-8844
Mailing Address - Fax:254-634-8844
Practice Address - Street 1:301 W STAN SCHLUETER LOOP
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-5282
Practice Address - Country:US
Practice Address - Phone:254-690-8844
Practice Address - Fax:254-634-8844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX175111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty