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General NPI Number Information
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NPI Number | 1093331696
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Entity Type | Individual
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Provider Name | MANUEL RODRIGUEZ DMD
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Gender | Male
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Dates
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Enumeration Date | 06/19/2020
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Last Update Date | 05/18/2021
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Provider Practice Location Address
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Address Line | 8245 N SILVERBELL RD STE 145
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City | TUCSON
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State | AZ
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Zip | 85743-7387
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Country | US
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Telephone | 520-881-8902
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 218
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City | CORTARO
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State | AZ
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Zip | 85652-0218
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Country | US
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Telephone | 520-256-3791
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D010735
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License Number State | AZ
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