Healthcare Provider Details

I. General information

NPI: 1265730915
Provider Name (Legal Business Name): DENTAL AGUILA S DE RL DE CV
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2011
Last Update Date: 03/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AV. 16 DE SEPTIEMBRE 335 LOCAL 9
PIEDRAS NEGROS COAHUILA
26010
MX

IV. Provider business mailing address

476 S. BIBB ST. STE C 525
EAGLE PASS TX
78852
US

V. Phone/Fax

Practice location:
  • Phone: 528787820206
  • Fax:
Mailing address:
  • Phone: 830-421-3348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: ROUL VILLALOBUS
Title or Position: MANAGER
Credential:
Phone: 830-421-3348