MEDICARE: DR. GAMALIEL ISSAC 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	AA828	AK

General Provider Information

NPI Number	:	1770597833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GAMALIEL ISSAC RODRIGUEZ DDS

Provider Business Mailing Address
First Line	:	2595 SAINT NICHOLAS DR
Second Line	:
City	:	NORTH POLE
State	:	AK
Zip	:	99705-7747
Country	:	US
Telephone Number	:	907-490-0127
Fax Number	:	907-490-4649

Provider Business Practice Location Address
First Line	:	2595 SAINT NICHOLAS DR
Second Line	:
City	:	NORTH POLE
State	:	AK
Zip	:	99705-7747
Country	:	US
Telephone Number	:	907-490-0127
Fax Number	:	907-490-4649

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	07/08/2007

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