Basic Information
| Provider Information | |||||||||
| NPI: | 1073825832 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | ALAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 204 E 1ST ST | ||||||||
| Address2: | |||||||||
| City: | ALICE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 783324822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3613960370 | ||||||||
| FaxNumber: | 3616642248 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 FLOURNOY RD | ||||||||
| Address2: | SUITE 2A | ||||||||
| City: | ALICE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 783324003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3616641417 | ||||||||
| FaxNumber: | 3616643218 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2010 | ||||||||
| LastUpdateDate: | 03/03/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 25698 | TX | Y | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | 1649265646 | 01 | TX | NPI BRYAN CHC | OTHER | 1821185299 | 01 | TX | BVCAA AGENCY NPI | OTHER | 1275620551 | 01 | TX | ROBERTSON CHC NPI | OTHER | 154467801 | 05 | TX | MEDICAID | 154467803 | 05 | TX | MEDICAID | 25698 | 01 | TX | SDBE DENTAL LICENSE | OTHER |