Healthcare Provider Details

I. General information

NPI: 1144646084
Provider Name (Legal Business Name): MONICA MARIE RODRIGUEZ -MONROIG DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2014
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2514 GUS THOMASSON RD
DALLAS TX
75228-3040
US

IV. Provider business mailing address

2514 GUS THOMASSON RD
DALLAS TX
75228-3040
US

V. Phone/Fax

Practice location:
  • Phone: 787-600-6806
  • Fax:
Mailing address:
  • Phone: 787-600-6806
  • Fax: 469-325-1515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number34752
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: