Organization Active NPI

Victor Rodriguez DDS, PA

Doing business as Clear Lake Dental Associates

  • Dentist
  • Houston, TX
National Provider Identifier
1295132827
Registry record updated Nov 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
18149 Issued in TX
Legal business name
VICTOR RODRIGUEZ DDS, PA
Doing business as
Clear Lake Dental Associates
Practice address
17225 El Camino Real
#150
Houston, TX 77058-2700
Phone
(281) 280-9380
Fax
(281) 280-9376
NPI assigned
Nov 25, 2014
Last updated
Nov 25, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2014

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

Authorized official

Name
Mr. Victor Rodriguez, DDSNPI 1639214661
Title
Dentist
Phone
(281) 280-9380

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 18149 TX Primary

Addresses

Primary practice location

17225 El Camino Real
#150
Houston, TX 77058-2700

Mailing address

17225 El Camino Real
#150
Houston, TX 77058-2700
Phone (281) 280-9380

Other identifiers 1

IdentifierTypeStateIssuer
1306854-07MedicaidTX

Other names 1

  • Clear Lake Dental Associates Doing business as

National Provider Directory

National Provider Directory

Locations

17225 El Camino Real
Ste 150
Houston, TX 77058
Phone (281) 256-4455

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1416873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416873600000",
    "number": "1295132827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17225 EL CAMINO REAL",
            "address_2": "#150",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770582700",
            "telephone_number": "281-280-9380",
            "fax_number": "281-280-9376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17225 EL CAMINO REAL",
            "address_2": "#150",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770582700",
            "telephone_number": "281-280-9380",
            "fax_number": "281-280-9376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTOR RODRIGUEZ DDS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-25",
        "last_updated": "2014-11-25",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "281-280-9380",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "18149",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1306854-07",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clear Lake Dental Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Houston, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.