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General NPI Number Information
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NPI Number | 1629244272
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Entity Type | Organization
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Legal Business Name | MAIRA M RODRIGUEZ DMD PC
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Dates
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Enumeration Date | 05/04/2008
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Last Update Date | 05/04/2008
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Provider Practice Location Address
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Address Line | 3288 BROAD ST
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City | DEXTER
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State | MI
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Zip | 48130-1153
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Country | US
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Telephone | 734-426-8292
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Fax | 734-426-9059
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Provider Business Mailing Address
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Address Line | 3288 BROAD ST
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City | DEXTER
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State | MI
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Zip | 48130-1153
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Country | US
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Telephone | 734-426-8292
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MAIRA M RODRIGUEZ
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Credential | DMD
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Telephone | 734-426-8292
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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 | 2901018189
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License Number State | MI
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