MEDICARE: DR. MARIA DE JESUS RODRIGUEZ DDS

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	1223P0221X	Pediatric Dentistry	20393	TX

General Provider Information

NPI Number	:	1396883351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIA DE JESUS RODRIGUEZ DDS

Provider Business Mailing Address
First Line	:	1002 W SAM HOUSTON ST STE 6
Second Line	:
City	:	PHARR
State	:	TX
Zip	:	78577-5198
Country	:	US
Telephone Number	:	956-781-8880
Fax Number	:	956-781-8977

Provider Business Practice Location Address
First Line	:	1002 W SAM HOUSTON ST STE 6
Second Line	:
City	:	PHARR
State	:	TX
Zip	:	78577-5198
Country	:	US
Telephone Number	:	956-781-8880
Fax Number	:	956-781-8977

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

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	07/08/2007

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