MEDICARE: DR. CARLA DAMARIS RODRIGUEZ D.M.D

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	2666	PR

General Provider Information

NPI Number	:	1730169293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLA DAMARIS RODRIGUEZ D.M.D

Provider Business Mailing Address
First Line	:	URB. RIVER GARDEN 137 FLOR DE MAR
Second Line	:
City	:	CANOVANAS
State	:	PR
Zip	:	00729-3350
Country	:	US
Telephone Number	:	787-638-6328
Fax Number	:	787-761-8425

Provider Business Practice Location Address
First Line	:	124 CALLE ARZUAGA
Second Line	:
City	:	RIO PIEDRAS
State	:	PR
Zip	:	00925-3302
Country	:	US
Telephone Number	:	787-765-7915
Fax Number	:

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

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	07/08/2007

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