=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255417010
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSEPH PAUL RODRIGUEZ D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2006
-----------------------------------------------------
Last Update Date | 04/24/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 171 W 10TH ST SUITE 100
-----------------------------------------------------
City | CHICAGO HEIGHTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60411-2072
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-503-5001
-----------------------------------------------------
Fax | 708-503-5008
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 171 W 10TH ST SUITE 100
-----------------------------------------------------
City | CHICAGO HEIGHTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60411-2072
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-503-5001
-----------------------------------------------------
Fax | 708-503-5008
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 019022809
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 019.022809
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------