Provider Demographics
NPI:1134378714
Name:RODRIGUEZ, LAURA R
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:R
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 S. EVANS ST
Mailing Address - Street 2:
Mailing Address - City:UVALDE
Mailing Address - State:TX
Mailing Address - Zip Code:78801-6034
Mailing Address - Country:US
Mailing Address - Phone:830-278-5604
Mailing Address - Fax:830-278-1836
Practice Address - Street 1:908 S EVANS
Practice Address - Street 2:
Practice Address - City:UVALDE
Practice Address - State:TX
Practice Address - Zip Code:78801-6034
Practice Address - Country:US
Practice Address - Phone:830-278-3765
Practice Address - Fax:830-278-3373
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0014682124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist