MEDICARE: DR. ELVA MAE 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	1223G0001X	General Practice Dentistry	17114	TX
2	1223G0001X	General Practice Dentistry	DE00008269	WA

General Provider Information

NPI Number	:	1871564476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELVA MAE RODRIGUEZ DDS

Provider Business Mailing Address
First Line	:	8056 ADELAIDE DR
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-8031
Country	:	US
Telephone Number	:	706-304-7647
Fax Number	:	706-341-0174

Provider Business Practice Location Address
First Line	:	7101 HOFF STREET,MEDDAC
Second Line	:	HEADQUARTERS,UNITED STATES ARMY DENTAL ACTIVITY
City	:	COLUMBUS
State	:	GA
Zip	:	31905-5610
Country	:	US
Telephone Number	:	706-544-2051
Fax Number	:

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

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	09/11/2025

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