Provider Demographics
NPI:1093976185
Name:RODRIGUEZ, MICHAEL A (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 277
Mailing Address - Street 2:554-850 MEDICAL CENTER DRIVE
Mailing Address - City:BIEBER
Mailing Address - State:CA
Mailing Address - Zip Code:96009-0277
Mailing Address - Country:US
Mailing Address - Phone:530-294-5629
Mailing Address - Fax:530-294-5392
Practice Address - Street 1:554-850 MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:BIEBER
Practice Address - State:CA
Practice Address - Zip Code:96009-0277
Practice Address - Country:US
Practice Address - Phone:530-294-5629
Practice Address - Fax:530-294-5392
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA327601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice