MEDICARE: DR. RUTH RODRIGUEZ D.D.S.

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	2325	PR
2	1223G0001X	General Practice Dentistry		IL

General Provider Information

NPI Number	:	1760407795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUTH RODRIGUEZ D.D.S.

Provider Business Mailing Address
First Line	:	654 AVE MUNOZ RIVERA
Second Line	:	SUITE 1104
City	:	SAN JUAN
State	:	PR
Zip	:	00918-4123
Country	:	US
Telephone Number	:	787-764-1414
Fax Number	:	787-763-3885

Provider Business Practice Location Address
First Line	:	654 AVE MUNOZ RIVERA
Second Line	:	SUITE 1104
City	:	SAN JUAN
State	:	PR
Zip	:	00918-4123
Country	:	US
Telephone Number	:	787-764-1414
Fax Number	:	787-763-3885

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	07/08/2007

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