MEDICARE: THOMAS M RODRIGUEZ DMD

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	30.026530	OH

General Provider Information

NPI Number	:	1861069262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS M RODRIGUEZ DMD

Provider Business Mailing Address
First Line	:	26747 BUTTERNUT RIDGE RD
Second Line	:
City	:	NORTH OLMSTED
State	:	OH
Zip	:	44070-4408
Country	:	US
Telephone Number	:	440-915-9723
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 MENTOR AVE STE 280
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-8715
Country	:	US
Telephone Number	:	440-352-2887
Fax Number	:

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

Provider Enumeration Date	:	06/06/2021
Last Update Date	:	01/06/2022

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