MEDICARE: DR. STEVE OMAR 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	S-1090	LA
2	1223G0001X	General Practice Dentistry	38386	TX
3	390200000X	Student in an Organized Health Care Education/Training Program		LA
4	1223G0001X	General Practice Dentistry	D012088	AZ

General Provider Information

NPI Number	:	1992988893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVE OMAR RODRIGUEZ DDS

Provider Business Mailing Address
First Line	:	16019 CHASE HILL BLVD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78255-1153
Country	:	US
Telephone Number	:	203-993-0889
Fax Number	:

Provider Business Practice Location Address
First Line	:	2990 S 6TH AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85713-4705
Country	:	US
Telephone Number	:	520-526-0578
Fax Number	:

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

Provider Enumeration Date	:	12/13/2007
Last Update Date	:	04/11/2024

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