Provider Demographics
NPI:1548346653
Name:RODRIGUEZ, JOHN G (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
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 1:2939 REGENCY DR
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-2216
Mailing Address - Country:US
Mailing Address - Phone:956-630-4900
Mailing Address - Fax:956-682-9806
Practice Address - Street 1:2939 REGENCY DR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-2216
Practice Address - Country:US
Practice Address - Phone:956-630-4900
Practice Address - Fax:956-682-9806
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX145661223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX693641OtherUNITED CONCORDIA PROVIDER
TXD14566OtherBC/BS PROVIDER (TEXAS)
TX120777102Medicaid
TXB14566OtherCHIP PROVIDER ID