Provider Demographics
NPI:1790009355
Name:GRACIELA RODRIGUEZ DDS PA
Entity Type:Organization
Organization Name:GRACIELA RODRIGUEZ DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GRACIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-968-9842
Mailing Address - Street 1:15634 WALLISVILLE RD
Mailing Address - Street 2:SUITE 900
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77049-4635
Mailing Address - Country:US
Mailing Address - Phone:713-968-9842
Mailing Address - Fax:504-617-6430
Practice Address - Street 1:15634 WALLISVILLE RD
Practice Address - Street 2:SUITE 900
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77049-4635
Practice Address - Country:US
Practice Address - Phone:713-968-9842
Practice Address - Fax:504-617-6430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX241461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX24146OtherLICENSE
TX24146OtherLICENSE