Provider Demographics
NPI:1528288206
Name:RODRIGUEZ, MARICELA (DDS)
Entity type:Individual
Prefix:DR
First Name:MARICELA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7405 SHALLOWFORD RD STE 210
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2662
Mailing Address - Country:US
Mailing Address - Phone:423-899-6949
Mailing Address - Fax:423-499-6191
Practice Address - Street 1:7405 SHALLOWFORD RD STE 210
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2662
Practice Address - Country:US
Practice Address - Phone:423-899-6949
Practice Address - Fax:423-499-6191
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN70661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice