MEDICARE: DR. ALONSO ARMENDARIZ DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	16759	TX

General Provider Information

NPI Number	:	1366572901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALONSO ARMENDARIZ DDS

Provider Business Mailing Address
First Line	:	PO BOX 1451
Second Line	:
City	:	RIO GRANDE CITY
State	:	TX
Zip	:	78582-1451
Country	:	US
Telephone Number	:	956-488-8354
Fax Number	:	956-488-8247

Provider Business Practice Location Address
First Line	:	1314 E SAN BENITO
Second Line	:
City	:	RIO GRANDE CITY
State	:	TX
Zip	:	78582-7858
Country	:	US
Telephone Number	:	956-488-8354
Fax Number	:	956-488-8247

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	07/08/2007

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