Healthcare Provider Details

I. General information

NPI: 1013452994
Provider Name (Legal Business Name): CLAUDIA M ANCIRA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2016
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 COUNTRY CLUB DR APT 5
LAREDO TX
78045-7549
US

IV. Provider business mailing address

1800 COUNTRY CLUB DR APT 5
LAREDO TX
78045-7549
US

V. Phone/Fax

Practice location:
  • Phone: 956-763-2625
  • Fax:
Mailing address:
  • Phone: 956-763-2625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number32501
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number32501
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number32501
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number32501
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: