Luis Acevedo Rodriguez, DDS
Individual provider Active NPI Dentist · Marysville, WA
NPI 1992114441 · NPPES record last updated Apr 17, 2026
Key facts
- NPI
- 1992114441
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DE60486352 (WA)
- Practice address
- 4922 Grove St
Marysville, WA 98270-4427 - Phone
- (360) 657-3091
- Fax
- (360) 657-5732
- NPI assigned
- Aug 8, 2014
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DE60486352 | WA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sea Mar Community Health Centers | Dentist | Past |
Accepting new patients |
| Sea Mar Community Health Centers | Dentist | Past | Accepting new patients |
Interoperability endpoints
- lacevedorodriguez452608@direct.multicare.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DE60486352 | WA | |
| Dentist | 122300000X | DE60486352 | WA | Yes |
Addresses
Primary practice location
4922 Grove St
Marysville, WA 98270-4427
Mailing address
PO Box 34703
Seattle, WA 98124-1703
Other practice location 1
17707 W Main St
Monroe, WA 98272-1967
Phone (360) 282-3900
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2037997 | Medicaid | WA |
Other providers in Marysville, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 17, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.