MEDICARE: DR. MIRILIS MIRIAM RODRIGUEZ DDS

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	1223G0001X	General Practice Dentistry	DN 20393	FL

General Provider Information

NPI Number	:	1356771224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIRILIS MIRIAM RODRIGUEZ DDS

Provider Business Mailing Address
First Line	:	11865 SW 26TH ST STEB-5
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-2471
Country	:	US
Telephone Number	:	305-360-7002
Fax Number	:	305-360-7009

Provider Business Practice Location Address
First Line	:	11865 SW 26TH ST STEB-5
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-2471
Country	:	US
Telephone Number	:	305-360-7002
Fax Number	:	305-360-7009

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

Provider Enumeration Date	:	11/13/2013
Last Update Date	:	08/30/2023

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