Jonathan Vasquez Rodriguez, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D011815 Issued in AZ

Practice address

40930 N Ironwood Dr Ste 109
Queen Creek, AZ 85140-8829

Phone

(480) 347-0753

NPI assigned

Jun 6, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

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

Specialty

Dentist

Education

University of Louisville School of Dentistry, 2023

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Desert Senita Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Ajo, AZ
  • NPI 1114037496

  Single Specialty

  Medicare reassignment NPD
• Desert Senita Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Coolidge, AZ
  • NPI 1386419927
  NPD
• Desert Senita Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Arizona City, AZ
  • NPI 1447124326
  NPD

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

{
    "created_epoch": "1686009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686009600000",
    "number": "1609560176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1057 S DEERFIELD LN",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852962898",
            "telephone_number": "904-294-2482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40930 N IRONWOOD DR STE 109",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "851408829",
            "telephone_number": "480-347-0753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "JONATHAN",
        "middle_name": "VASQUEZ",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-06-06",
        "last_updated": "2023-06-06",
        "certification_date": "2023-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D011815",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marci Roberts
• Jenna Joann- Mae Robertson
• Chris M Robinson, D.C.
• Teresa Evette Robinson, PMHNP-BC
• Alberto Aguilar Rodriguez, NIM TECH
• Dianne M Rogers, PSYD, MSCP
• Monica Rogers
• Mai-Lin Rollon, CNM
• Brandi Romero, COTA/L
• Siqiang Rong, DMD

• General Practice Dentistry in Queen Creek, AZ
• Providers in Queen Creek, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.