MEDICARE: GRETA BARBAN 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	24497	FL

General Provider Information

NPI Number	:	1093174476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRETA BARBAN RODRIGUEZ D.D.S

Provider Business Mailing Address
First Line	:	1400 NW 12 AVE
Second Line	:	SUITE 2005 ORAL SURGERY,
City	:	MIAMI
State	:	FL
Zip	:	33136
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1544 W 37TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4613
Country	:	US
Telephone Number	:	305-558-9222
Fax Number	:

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

Provider Enumeration Date	:	02/15/2016
Last Update Date	:	12/08/2019

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