=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023810538
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DESTANY PAIGE RODRIGUEZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2025
-----------------------------------------------------
Last Update Date | 03/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 93 CHURCHILL ST
-----------------------------------------------------
City | WISCASSET
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04578-4101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-386-6600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2301 STATE ROUTE 129
-----------------------------------------------------
City | SOUTH BRISTOL
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04568-4703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-682-8481
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 124Q00000X
-----------------------------------------------------
Taxonomy Name | Dental Hygienist
-----------------------------------------------------
License Number | RDH4628
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------