Healthcare Provider Details

I. General information

NPI: 1336848498
Provider Name (Legal Business Name): BRIANNA ASHLEY RODMAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13533 PEACH GROVE RD
CALIFORNIA KY
41007-8745
US

IV. Provider business mailing address

13533 PEACH GROVE RD
CALIFORNIA KY
41007-8745
US

V. Phone/Fax

Practice location:
  • Phone: 254-206-0838
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11431
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: