Provider Demographics
NPI:1376855726
Name:RODRIGUEZ, EMILY MARIE (DDS)
Entity Type:Individual
Prefix:MISS
First Name:EMILY
Middle Name:MARIE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 W AYCOCK ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27608-2503
Mailing Address - Country:US
Mailing Address - Phone:410-991-0826
Mailing Address - Fax:
Practice Address - Street 1:109 W AYCOCK ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27608-2503
Practice Address - Country:US
Practice Address - Phone:410-991-0826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC90021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice