MEDICARE: DR. ROBERT C RODRIGUEZ

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	7402	IA

General Provider Information

NPI Number	:	1275628315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT C RODRIGUEZ

Provider Business Mailing Address
First Line	:	1615 32ND ST NE
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52402-4072
Country	:	US
Telephone Number	:	319-294-2323
Fax Number	:	319-395-6715

Provider Business Practice Location Address
First Line	:	1615 32ND ST NE
Second Line	:
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52402-4072
Country	:	US
Telephone Number	:	319-294-2323
Fax Number	:	319-395-6715

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	07/08/2007

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