Healthcare Provider Details

I. General information

NPI: 1609387612
Provider Name (Legal Business Name): RODRIGUEZ DENTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2017
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 EXECUTIVE PLACE, SUITE A
SPRINGDALE AR
72762
US

IV. Provider business mailing address

1521 EXECUTIVE PLACE, SUITE A
SPRINGDALE AR
72762
US

V. Phone/Fax

Practice location:
  • Phone: 870-270-0452
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: RACHAEL LOUISE RODRIGUEZ
Title or Position: DDS, MEMBER
Credential:
Phone: 479-250-1516