Provider Demographics
NPI:1851309934
Name:RODRIGUE, MARVIN DALE JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:DALE
Last Name:RODRIGUE
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2729 SILVERLAKE PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-1852
Mailing Address - Country:US
Mailing Address - Phone:713-436-4555
Mailing Address - Fax:281-412-6784
Practice Address - Street 1:2729 SILVERLAKE PKWY STE 101
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-1852
Practice Address - Country:US
Practice Address - Phone:713-436-4555
Practice Address - Fax:281-412-6784
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18878122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX147089001Medicaid
TX969593OtherUNITED CONCORDIA