Healthcare Provider Details

I. General information

NPI: 1447453626
Provider Name (Legal Business Name): ROEL GARZA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 COYOTE TRL
ALICE TX
78332-4004
US

IV. Provider business mailing address

750 COYOTE TRAIL
ALICE TX
78332
US

V. Phone/Fax

Practice location:
  • Phone: 361-668-3384
  • Fax: 361-668-6191
Mailing address:
  • Phone: 361-668-3384
  • Fax: 361-668-6191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number17020
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: