Angel Emmanuel Rodriguez Pena, DDS, MSD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

104508 Issued in CA

Practice address

8938 S Broadway Ave Ste 480
Tyler, TX 75703-5733

Phone

(918) 801-8124

NPI assigned

Aug 22, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jun 6, 2023 through Jun 6, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Perio Implant Health Professionals

  • Periodontics
  • Los Angeles, CA
  • NPI 1992914196
  NPD (past)

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

{
    "created_epoch": "1534896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645574400000",
    "number": "1639650245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11950 ERWIN ST APT 337",
            "city": "NORTH HOLLYWOOD",
            "state": "CA",
            "postal_code": "91606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8938 S BROADWAY AVE STE 480",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757035733",
            "telephone_number": "918-801-8124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ PENA",
        "first_name": "ANGEL",
        "middle_name": "EMMANUEL",
        "name_prefix": "Dr.",
        "credential": "DDS, MSD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-08-22",
        "last_updated": "2022-02-23",
        "certification_date": "2022-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "TX",
            "license": "34440",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "104508",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathryn M Rodgers
• Mary Rodgers
• Randall W Rodgers, D.O.
• Isaac Rodgerson
• Maria Isabel Rodriguez Mendez
• Elijah Luis Rodriguez, MA, LPC-A
• Jesus Rodriguez
• Julieanne Rodriguez
• Tracy Rodriguez, NP
• Elizabeth Cross Roe, P.A.-C

• Periodontics in Tyler, TX
• Providers in Tyler, TX by specialty
• Periodontics in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2022; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.