MEDICARE: RODRIGO SARMENTO DMD, MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	390200000X	Student in an Organized Health Care Education/Training Program	BP10081062	TX
3	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	13441	NC

General Provider Information

NPI Number	:	1093270399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RODRIGO SARMENTO DMD, MD

Provider Business Mailing Address
First Line	:	11629 SOUTHCREST LN
Second Line	:
City	:	PINEVILLE
State	:	NC
Zip	:	28134-9157
Country	:	US
Telephone Number	:	727-656-4827
Fax Number	:

Provider Business Practice Location Address
First Line	:	12312 COPPER WAY STE 100
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-4856
Country	:	US
Telephone Number	:	704-541-6070
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2019
Last Update Date	:	07/09/2025

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