MEDICARE: DR. HERMINIA D. RODRIGUEZ D.M.D., P.A.

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	DN10606	FL

General Provider Information

NPI Number	:	1386744845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HERMINIA D. RODRIGUEZ D.M.D., P.A.

Provider Business Mailing Address
First Line	:	1640 S VOLUSIA AVE
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-7335
Country	:	US
Telephone Number	:	386-775-4911
Fax Number	:	386-775-6229

Provider Business Practice Location Address
First Line	:	1640 S VOLUSIA AVE
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-7335
Country	:	US
Telephone Number	:	386-775-4911
Fax Number	:

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

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	05/26/2017

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