Individual provider Active NPI

Adam Patrick Rodriguez, DDS

  • Pediatric Dentistry
  • North Las Vegas, NV
National Provider Identifier
1629630496
Registry record updated Nov 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
S6-239 Issued in NV
Practice address
955 W Craig Rd Ste 106
North Las Vegas, NV 89032-0279
Phone
(702) 522-2272
NPI assigned
Jul 2, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X S6-239 NV Primary

Addresses

Primary practice location

955 W Craig Rd Ste 106
North Las Vegas, NV 89032-0279

Mailing address

955 W Craig Rd Ste 106
North Las Vegas, NV 89032-0279
Phone (909) 568-9232

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
I20191030001819 CA Order and Referring Only - DentistPractitioner - Dentist 1153653878

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
S6-239NVMDPediatric Dentist

NPI Registry JSON

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

{
    "created_epoch": "1562025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763769600000",
    "number": "1629630496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "955 W CRAIG RD STE 106",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890320279",
            "telephone_number": "909-568-9232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "955 W CRAIG RD STE 106",
            "city": "NORTH LAS VEGAS",
            "state": "NV",
            "postal_code": "890320279",
            "telephone_number": "702-522-2272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "ADAM",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-02",
        "last_updated": "2025-11-22",
        "certification_date": "2025-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NV",
            "license": "S6-239",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.