Provider Demographics
NPI:1972938496
Name:RODRIGUEZ, SANDRA MARIA (DDS)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:MARIA
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 1:2507 WILLIAMS GRANT ST
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-1545
Mailing Address - Country:US
Mailing Address - Phone:281-701-4268
Mailing Address - Fax:
Practice Address - Street 1:2640 E LEAGUE CITY PKWY
Practice Address - Street 2:UNIT 108
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-3368
Practice Address - Country:US
Practice Address - Phone:281-701-4268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-04
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX290441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice