MEDICARE: DR. LUIS RODRIGUEZ D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN12054	FL

General Provider Information

NPI Number	:	1023198397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUIS RODRIGUEZ D.D.S.

Provider Business Mailing Address
First Line	:	1874 SW 138TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-7500
Country	:	US
Telephone Number	:	305-553-4779
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 N ROYAL POINCIANA BLVD
Second Line	:	SUITE #200
City	:	MIAMI SPRINGS
State	:	FL
Zip	:	33166-4423
Country	:	US
Telephone Number	:	305-884-2751
Fax Number	:	305-884-6119

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	07/08/2007

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