Individual provider Active NPI

Nathalie Sardenberg Rodrigues, DDS

  • General Practice Dentistry
  • San Rafael, CA
National Provider Identifier
1265210504
Registry record updated Sep 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DDS109243 Issued in CA
Practice address
801 A St Ste 1
San Rafael, CA 94901-3010
Phone
(415) 460-9744
NPI assigned
Sep 18, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DDS109243 CA Primary

Addresses

Primary practice location

801 A St Ste 1
San Rafael, CA 94901-3010

Mailing address

801 A St Ste 1
San Rafael, CA 94901-3010
Phone (415) 460-9744

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240904000166 CA Order and Referring Only - DentistPractitioner - Dentist 0941749030

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DDS109243CAMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1694995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694995200000",
    "number": "1265210504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 A ST STE 1",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949013010",
            "telephone_number": "415-460-9744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 A ST STE 1",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949013010",
            "telephone_number": "415-460-9744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SARDENBERG RODRIGUES",
        "first_name": "NATHALIE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-18",
        "last_updated": "2023-09-18",
        "certification_date": "2023-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "DDS109243",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Rafael, CA

Sources for this page

Verify at the official NPI Registry.