Provider Demographics
NPI:1083019525
Name:SHWETHA RODRIGUES DDS PC
Entity Type:Organization
Organization Name:SHWETHA RODRIGUES DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHWETHA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-748-2555
Mailing Address - Street 1:12517 JEFFERSON DAVIS HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831
Mailing Address - Country:US
Mailing Address - Phone:804-748-2555
Mailing Address - Fax:804-748-3798
Practice Address - Street 1:12517 JEFFERSON DAVIS HIGHWAY
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831
Practice Address - Country:US
Practice Address - Phone:804-748-2555
Practice Address - Fax:804-748-3798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-27
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410819305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA=========OtherITIN