Basic Information
Provider Information
NPI: 1134378714
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RODRIGUEZ
FirstName: LAURA
MiddleName: R.
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 908 S. EVANS ST
Address2:  
City: UVALDE
State: TX
PostalCode: 788016034
CountryCode: US
TelephoneNumber: 8302785604
FaxNumber: 8302781836
Practice Location
Address1: 908 S EVANS
Address2:  
City: UVALDE
State: TX
PostalCode: 788016034
CountryCode: US
TelephoneNumber: 8302783765
FaxNumber: 8302783373
Other Information
ProviderEnumerationDate: 09/18/2008
LastUpdateDate: 03/29/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
124Q00000X0014682TXY Dental ProvidersDental Hygienist 

No ID Information.


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