MEDICARE: DR. MERLLORY LAMPE 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
1	390200000X	Student in an Organized Health Care Education/Training Program
2	1223G0001X	General Practice Dentistry	DN29666	FL

General Provider Information

NPI Number	:	1386407047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MERLLORY LAMPE RODRIGUEZ DMD

Provider Business Mailing Address
First Line	:	12386 STATE ROAD 535 # 236
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32836-6701
Country	:	US
Telephone Number	:	321-337-5189
Fax Number	:

Provider Business Practice Location Address
First Line	:	5845 WINTER GARDEN VINELAND RD
Second Line	:
City	:	WINDERMERE
State	:	FL
Zip	:	34786-6124
Country	:	US
Telephone Number	:	407-258-3156
Fax Number	:

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

Provider Enumeration Date	:	02/05/2024
Last Update Date	:	10/01/2024

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