Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 35505 | TX |
NPI | 1073175444 |
---|---|
Provider Name | Dr. Nicholas Rodriguez |
First Address | Mcallen, TX 78503-3066 |
Second Address | Arlington, TX 76016-5601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2019 |
Last Update Date | 26/01/2022 |