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NPI Code Detail

MEDICARE: MS. CYBILL LISA RODRIGUEZ DMD

MEDICARE: MS. CYBILL LISA RODRIGUEZ DMD
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
1122300000XDentist019.032346IL

General Provider Information

NPI Number : 1083260301
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CYBILL LISA RODRIGUEZ DMD
Provider Business Mailing Address
First Line : 6348 S AUSTIN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60638-5341
Country : US
Telephone Number : 773-454-2858
Fax Number :
Provider Business Practice Location Address
First Line : 3501 N HALSTED ST
Second Line :
City : CHICAGO
State : IL
Zip : 60657-1832
Country : US
Telephone Number : 773-388-1600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2019
Last Update Date : 09/27/2024

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