MEDICARE: DR. MAYRA LUZ RODRIGUEZ D.M.D

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	DN18010	FL

General Provider Information

NPI Number	:	1972703254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAYRA LUZ RODRIGUEZ D.M.D

Provider Business Mailing Address
First Line	:	23082 SANDALFOOT PLAZA DR
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33428-6654
Country	:	US
Telephone Number	:	561-953-9393
Fax Number	:	561-684-6564

Provider Business Practice Location Address
First Line	:	23082 SANDALFOOT PLAZA DR
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33428-6654
Country	:	US
Telephone Number	:	561-953-9393
Fax Number	:	561-684-6564

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

Provider Enumeration Date	:	07/24/2007
Last Update Date	:	10/15/2015

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