MEDICARE: LINDALE MEDICAL DENTAL GROUP

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	2085U0001X	Diagnostic Ultrasound Physician

General Provider Information

NPI Number	:	1700942653
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LINDALE MEDICAL DENTAL GROUP

Provider Business Mailing Address
First Line	:	500 PAREDES LINE RD
Second Line	:	#3
City	:	BROWNSVILLE
State	:	TX
Zip	:	78521-2583
Country	:	US
Telephone Number	:	956-541-2162
Fax Number	:	956-541-8043

Provider Business Practice Location Address
First Line	:	500 PAREDES LINE RD
Second Line	:	#3
City	:	BROWNSVILLE
State	:	TX
Zip	:	78521-2583
Country	:	US
Telephone Number	:	956-541-2162
Fax Number	:	956-541-8043

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	DR. ERNESTO S DAVILA
Credential	:	DDS
Telephone Number	:	956-541-2162

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	03/18/2008

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