=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033794730
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTIANA RHODES DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2021
-----------------------------------------------------
Last Update Date | 06/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2133 KLINKER STREET BUILDING 3352
-----------------------------------------------------
City | JBSA-LACKLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78236-5313
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-292-6258
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 338 S DAKOTA AVE
-----------------------------------------------------
City | VANDENBERG AFB
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93437-6307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | D011067
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------