Individual
KAILEEN RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1001 SHADOW LN # MS 7442, LAS VEGAS, NV 89106-4124
(702) 774-2698
Mailing address
1001 SHADOW LN # MS 7442, LAS VEGAS, NV 89106-4124
(702) 774-2698
(702) 774-2696
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
101704
CA
1223G0001X
General Practice Dentistry
Primary
LL-549-21
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
VAD0000
—
CA
Enumeration date
07/27/2017
Last updated
12/06/2021
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