Provider Demographics
NPI:1184066128
Name:RODRIGUEZ, JAMES MERVIN (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MERVIN
Last Name:RODRIGUEZ
Suffix:
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 1:44 HOLIDAY DR
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:CA
Mailing Address - Zip Code:94507-2116
Mailing Address - Country:US
Mailing Address - Phone:925-788-1248
Mailing Address - Fax:
Practice Address - Street 1:106 LA CASA VIA STE 280
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3015
Practice Address - Country:US
Practice Address - Phone:925-932-2112
Practice Address - Fax:925-743-9682
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD22839122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist