Healthcare Provider Details

I. General information

NPI: 1811430929
Provider Name (Legal Business Name): RIO VISTA DENTISTRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 01/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 S LOOP 499 STE 1
HARLINGEN TX
78550-2519
US

IV. Provider business mailing address

802 S LOOP 499 STE 1
HARLINGEN TX
78550-2519
US

V. Phone/Fax

Practice location:
  • Phone: 956-425-7726
  • Fax: 956-428-6822
Mailing address:
  • Phone: 956-425-7726
  • Fax: 956-428-6822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number20241
License Number StateTX

VIII. Authorized Official

Name: JONATHAN K JAMES
Title or Position: DENTIST
Credential: DDS
Phone: 956-425-7726