Provider Demographics
NPI:1023810538
Name:RODRIGUEZ, DESTANY PAIGE
Entity type:Individual
Prefix:
First Name:DESTANY
Middle Name:PAIGE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 STATE ROUTE 129
Mailing Address - Street 2:
Mailing Address - City:SOUTH BRISTOL
Mailing Address - State:ME
Mailing Address - Zip Code:04568-4703
Mailing Address - Country:US
Mailing Address - Phone:207-682-8481
Mailing Address - Fax:
Practice Address - Street 1:93 CHURCHILL ST
Practice Address - Street 2:
Practice Address - City:WISCASSET
Practice Address - State:ME
Practice Address - Zip Code:04578-4101
Practice Address - Country:US
Practice Address - Phone:207-386-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERDH4628124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist