Provider Demographics
NPI:1760173777
Name:RODRIGUEZ, MARIELYS JANICE (DMD)
Entity type:Individual
Prefix:DR
First Name:MARIELYS
Middle Name:JANICE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14864 SUMMER BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-5130
Mailing Address - Country:US
Mailing Address - Phone:813-435-8332
Mailing Address - Fax:
Practice Address - Street 1:10672 BLOOMINGDALE AVE UNIT 102
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-4291
Practice Address - Country:US
Practice Address - Phone:813-454-0776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-19
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30649122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist