Individual provider Active NPI

Pedro A Rodriguez, D.D.S.

  • Dentist
  • Niles, OH
National Provider Identifier
1790930725
Registry record updated Oct 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
30-022921 Issued in OH
Practice address
680 Youngstown-Warren Rd
Niles, OH 44446
Phone
(330) 989-6550
Fax
(330) 989-6551
NPI assigned
Nov 18, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 23, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 30-022921 OH Primary

Addresses

Primary practice location

680 Youngstown-Warren Rd
Niles, OH 44446

Mailing address

680 Youngstown-Warren Rd
Niles, OH 44446
Phone (330) 989-6550

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
30-022921OHMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1226966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350950400000",
    "number": "1790930725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "680 YOUNGSTOWN-WARREN RD",
            "city": "NILES",
            "state": "OH",
            "postal_code": "44446",
            "telephone_number": "330-989-6550",
            "fax_number": "330-989-6551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "680 YOUNGSTOWN-WARREN RD",
            "city": "NILES",
            "state": "OH",
            "postal_code": "44446",
            "telephone_number": "330-989-6550",
            "fax_number": "330-989-6551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "PEDRO",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-11-18",
        "last_updated": "2012-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "30-022921",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Niles, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2012; 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.