Healthcare Provider Details

I. General information

NPI: 1699381400
Provider Name (Legal Business Name): HOLA DENTAL S DE RL DE CV
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2020
Last Update Date: 09/17/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

C. ZARAGOZA 603 LOCAL B
PIEDRAS NEGRAS COAHUILA
26000
MX

IV. Provider business mailing address

2016 E GARRISON ST STE 2-150
EAGLE PASS TX
78852-5068
US

V. Phone/Fax

Practice location:
  • Phone: 830-421-3320
  • Fax:
Mailing address:
  • Phone: 830-421-3320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RAUL VILLALOBOS
Title or Position: MANAGER
Credential:
Phone: 202-413-5391