Provider Demographics
NPI:1508561317
Name:RODRIGUEZ BOADA, MARTHA JULIANA (DMD)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:JULIANA
Last Name:RODRIGUEZ BOADA
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4509 WHITTEMORE PL
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6270
Mailing Address - Country:US
Mailing Address - Phone:407-617-4582
Mailing Address - Fax:
Practice Address - Street 1:3350 COMMISSION CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-1784
Practice Address - Country:US
Practice Address - Phone:703-680-7950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH26428124Q00000X
DCHYG1001025124Q00000X
VA0401419084122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No124Q00000XDental ProvidersDental Hygienist