Basic Information
Provider Information
NPI: 1003000654
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RHODES
FirstName: CAROLINE
MiddleName: MARIE
NamePrefix: DR.
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 20821 US HWY 281 SUITE 310
Address2: STONE OAK MODERN DENTISTRY
City: SAN ANTONIO
State: TX
PostalCode: 78258
CountryCode: US
TelephoneNumber: 2104944488
FaxNumber:  
Practice Location
Address1: 20821 US HWY 281 SUITE 310
Address2: STONE OAK MODERN DENTISTRY
City: SAN ANTONIO
State: TX
PostalCode: 78258
CountryCode: US
TelephoneNumber: 2104944488
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/28/2007
LastUpdateDate: 06/10/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223G0001X3531-09MSN Dental ProvidersDentistGeneral Practice
1223G0001X26299TXY Dental ProvidersDentistGeneral Practice
1223G0001X55219CAN Dental ProvidersDentistGeneral Practice

No ID Information.


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