Provider Demographics
NPI:1871564476
Name:RODRIGUEZ, ELVA MAE (DDS)
Entity type:Individual
Prefix:DR
First Name:ELVA
Middle Name:MAE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8056 ADELAIDE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-8031
Mailing Address - Country:US
Mailing Address - Phone:706-304-7647
Mailing Address - Fax:706-341-0174
Practice Address - Street 1:7101 HOFF STREET,MEDDAC
Practice Address - Street 2:HEADQUARTERS,UNITED STATES ARMY DENTAL ACTIVITY
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31905-5610
Practice Address - Country:US
Practice Address - Phone:706-544-2051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171141223G0001X
WADE000082691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice