Healthcare Provider Details

I. General information

NPI: 1225676430
Provider Name (Legal Business Name): DMA PROFESSIONAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2019
Last Update Date: 07/06/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DEGOLLADO 2229
NUEVO LAREDO TAMAULIPAS
88240
MX

IV. Provider business mailing address

1806 COMMERCE DR STE 203
LAREDO TX
78041-2884
US

V. Phone/Fax

Practice location:
  • Phone: 956-999-8345
  • Fax:
Mailing address:
  • Phone: 956-999-8345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: FRANCISCO J NUNEZ JR.
Title or Position: PRESIDENT
Credential:
Phone: 956-999-8345