Healthcare Provider Details

I. General information

NPI: 1144518572
Provider Name (Legal Business Name): GRICELDA CARREON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2011
Last Update Date: 07/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PEDRO J. MENDEZ NO. 1827 SUITE. 204
REYNOSA TAMAULIPAS
88650
MX

IV. Provider business mailing address

5314 N 15TH ST APT 2
MCALLEN TX
78504-3442
US

V. Phone/Fax

Practice location:
  • Phone: 899-922-2716
  • Fax:
Mailing address:
  • Phone: 956-566-0975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1286042
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: