Provider Demographics
NPI:1396889481
Name:RODRIGUEZ, MARTA M (DMD)
Entity type:Individual
Prefix:DR
First Name:MARTA
Middle Name:M
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1127
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-1127
Mailing Address - Country:US
Mailing Address - Phone:787-883-3998
Mailing Address - Fax:787-883-3998
Practice Address - Street 1:694 ST, BARRIO ESPINOSA KM. 0.1
Practice Address - Street 2:SUITE 3 PLAZA SANTA ANA
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692-1127
Practice Address - Country:US
Practice Address - Phone:787-883-3998
Practice Address - Fax:787-883-3998
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR26001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice