Healthcare Provider Details

I. General information

NPI: 1891475109
Provider Name (Legal Business Name): MARIA DE LOS ANGELES RODRIGUEZ DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2023
Last Update Date: 08/15/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

567 W 14TH ST
CHICAGO HEIGHTS IL
60411-2386
US

IV. Provider business mailing address

519 CEDAR CT
MUNSTER IN
46321-2402
US

V. Phone/Fax

Practice location:
  • Phone: 708-283-9800
  • Fax:
Mailing address:
  • Phone: 786-571-3053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.034564
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: