Healthcare Provider Details

I. General information

NPI: 1366767436
Provider Name (Legal Business Name): ANDREA M. RODRIGUEZ, DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 04/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8105 CULEBRA RD
SAN ANTONIO TX
78251-1634
US

IV. Provider business mailing address

8105 CULEBRA RD
SAN ANTONIO TX
78251-1634
US

V. Phone/Fax

Practice location:
  • Phone: 210-681-9780
  • Fax: 210-681-7029
Mailing address:
  • Phone: 210-681-9780
  • Fax: 210-681-7029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number23474
License Number StateTX

VIII. Authorized Official

Name: DR. ANDREA MARIE RODRIGUEZ
Title or Position: DENTAL/SOLE PROPRIETOR
Credential: DDS
Phone: 210-681-9780