# MAIRA M RODRIGUEZ DMD PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Broad Street Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629244272
- **Authorized official:** DR. MAIRA M RODRIGUEZ DMD (PRESIDENT)
- **Authorized official phone:** (734) 426-8292

## Contact information

- **Practice address:** 3288 BROAD ST, DEXTER, MI 48130-1153
- **Practice address phone:** (734) 426-8292
- **Practice address fax:** (734) 426-9059
- **Mailing address:** 3288 BROAD ST, DEXTER, MI 48130-1153
- **Mailing address phone:** (734) 426-8292

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 2901018189 | MI | Yes |

## Other

- **Enumeration date:** 05/04/2008
- **Last updated:** 05/04/2008