MEDICARE: KENIA 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	122300000X	Dentist	31014	TX

General Provider Information

NPI Number	:	1639580095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENIA RODRIGUEZ

Provider Business Mailing Address
First Line	:	1230 DEKALB AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-3204
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2428 W ILLINOIS AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75233-1106
Country	:	US
Telephone Number	:	214-330-0222
Fax Number	:

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

Provider Enumeration Date	:	05/19/2014
Last Update Date	:	09/30/2015

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Directions to “ KENIA RODRIGUEZ ” Practice Location

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