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General NPI Number Information
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NPI Number | 1508561317
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Entity Type | Individual
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Provider Name | MARTHA JULIANA RODRIGUEZ BOADA DMD
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Gender | Female
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Dates
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Enumeration Date | 04/03/2023
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 3350 COMMISSION CT
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City | WOODBRIDGE
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State | VA
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Zip | 22192-1784
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Country | US
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Telephone | 703-680-7950
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Fax |
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Provider Business Mailing Address
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Address Line | 4509 WHITTEMORE PL
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City | FAIRFAX
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State | VA
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Zip | 22030-6270
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Country | US
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Telephone | 407-617-4582
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH26428
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | HYG1001025
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401419084
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License Number State | VA
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