Healthcare Provider Details

I. General information

NPI: 1245666916
Provider Name (Legal Business Name): ZOO DENTAL OF EDINBURG PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2013
Last Update Date: 09/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 S CLOSNER BLVD
EDINBURG TX
78539-5662
US

IV. Provider business mailing address

1156 W MONTE CRISTO RD
EDINBURG TX
78541-4541
US

V. Phone/Fax

Practice location:
  • Phone: 956-380-0070
  • Fax: 956-380-0090
Mailing address:
  • Phone: 956-380-0070
  • Fax: 956-380-0090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number23727
License Number StateTX

VIII. Authorized Official

Name: MR. SERGEY V BONDAR
Title or Position: PRESIDENT
Credential: DDS
Phone: 956-380-0070