Healthcare Provider Details

I. General information

NPI: 1538096193
Provider Name (Legal Business Name): LARISSA N RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E WEST HWY # 3
SILVER SPRING MD
20910-8200
US

IV. Provider business mailing address

650 REALM CT W
ODENTON MD
21113-1559
US

V. Phone/Fax

Practice location:
  • Phone: 240-534-1661
  • Fax:
Mailing address:
  • Phone: 301-674-3569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number9292
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: