Provider Demographics
NPI:1790807337
Name:RODRIGUEZ, ALICIA GABRIELLA (DDS)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:GABRIELLA
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 1:18 JOHNSTON BLVD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806
Mailing Address - Country:US
Mailing Address - Phone:828-254-1561
Mailing Address - Fax:828-254-1599
Practice Address - Street 1:18 JOHNSTON BLVD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806
Practice Address - Country:US
Practice Address - Phone:828-254-1561
Practice Address - Fax:828-254-1599
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC63801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8997457Medicaid