MEDICARE: DR. ROXANA 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	122300000X	Dentist	0401417679	VA
2	1223P0300X	Periodontics	26764	FL

General Provider Information

NPI Number	:	1659049880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROXANA RODRIGUEZ DDS

Provider Business Mailing Address
First Line	:	3383 NE 4TH ST
Second Line	:
City	:	HOMESTEAD
State	:	FL
Zip	:	33033-7129
Country	:	US
Telephone Number	:	786-395-4122
Fax Number	:

Provider Business Practice Location Address
First Line	:	21200 SAINT ANDREWS BLVD
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33433-2403
Country	:	US
Telephone Number	:	561-571-7108
Fax Number	:

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

Provider Enumeration Date	:	09/02/2021
Last Update Date	:	08/02/2024

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