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General NPI Number Information
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NPI Number | 1760173777
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Entity Type | Individual
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Provider Name | MARIELYS JANICE RODRIGUEZ DMD
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Gender | Female
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Dates
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Enumeration Date | 05/19/2023
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 10672 BLOOMINGDALE AVE UNIT 102
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City | RIVERVIEW
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State | FL
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Zip | 33578-4291
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Country | US
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Telephone | 813-454-0776
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Fax |
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Provider Business Mailing Address
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Address Line | 14864 SUMMER BRANCH DR
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City | LITHIA
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State | FL
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Zip | 33547-5130
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Country | US
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Telephone | 813-435-8332
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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 | 30649
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License Number State | FL
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