Provider Demographics
NPI:1508358664
Name:RODRIGUEZ, CASSANDRA (DDS)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
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 1:1522 S GILBERT RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-4018
Mailing Address - Country:US
Mailing Address - Phone:480-900-8848
Mailing Address - Fax:
Practice Address - Street 1:1522 S GILBERT RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-4018
Practice Address - Country:US
Practice Address - Phone:480-900-8848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010225921223G0001X
AZD0112441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice