Provider Demographics
NPI:1730377425
Name:RODRIGUES, SMITA JOCKIM (DDS)
Entity type:Individual
Prefix:DR
First Name:SMITA
Middle Name:JOCKIM
Last Name:RODRIGUES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2344 EL CAMINO REAL
Mailing Address - Street 2:SUITE-120
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-4072
Mailing Address - Country:US
Mailing Address - Phone:408-260-0770
Mailing Address - Fax:408-260-0680
Practice Address - Street 1:2344 EL CAMINO REAL
Practice Address - Street 2:SUITE-120
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-4072
Practice Address - Country:US
Practice Address - Phone:408-260-0770
Practice Address - Fax:408-260-0680
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2022-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA489861223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1679826481OtherNPI TYPE II