Provider Demographics
NPI:1508561317
Name:RODRIGUEZ, MARTHA JULIANA (DDS)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:JULIANA
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 1:4509 WHITTEMORE PL
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6270
Mailing Address - Country:US
Mailing Address - Phone:407-617-4582
Mailing Address - Fax:
Practice Address - Street 1:10 CENTER DRIVE NIHBC 10 - CRC BG RM 1-5673
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20892-0001
Practice Address - Country:US
Practice Address - Phone:407-617-4582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH26428124Q00000X
DCHYG1001025124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist