Provider Demographics
NPI:1770676470
Name:RODRIGUES, OLIVIA MADELINE (DDS)
Entity Type:Individual
Prefix:MS
First Name:OLIVIA
Middle Name:MADELINE
Last Name:RODRIGUES
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 1:7471 WATT AVE
Mailing Address - Street 2:SUITE 107A
Mailing Address - City:NORTH HIGHLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:95660-2632
Mailing Address - Country:US
Mailing Address - Phone:916-331-1211
Mailing Address - Fax:916-331-1287
Practice Address - Street 1:7471 WATT AVE
Practice Address - Street 2:SUITE 107A
Practice Address - City:NORTH HIGHLANDS
Practice Address - State:CA
Practice Address - Zip Code:95660-2632
Practice Address - Country:US
Practice Address - Phone:916-331-1211
Practice Address - Fax:916-331-1287
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA308651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice