Provider Demographics
NPI:1760889711
Name:ALBERTH RODRIGUEZ DDS LLC
Entity Type:Organization
Organization Name:ALBERTH RODRIGUEZ DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERTH
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-595-3512
Mailing Address - Street 1:3900 16TH ST NW
Mailing Address - Street 2:SUITE 115
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-8302
Mailing Address - Country:US
Mailing Address - Phone:202-595-3512
Mailing Address - Fax:202-864-0734
Practice Address - Street 1:3900 16TH ST NW
Practice Address - Street 2:SUITE 115
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-8302
Practice Address - Country:US
Practice Address - Phone:202-595-3512
Practice Address - Fax:202-864-0734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-19
Last Update Date:2015-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN1001404122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC046230100Medicaid