Healthcare Provider Details

I. General information

NPI: 1518145648
Provider Name (Legal Business Name): CITY OF LAREDO HEALTH DEPARTMENT DENTAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date: 10/09/2017
Reactivation Date: 10/24/2017

III. Provider practice location address

2600 CEDAR
LAREDO TX
78044-2337
US

IV. Provider business mailing address

PO BOX 6028
SAN ANTONIO TX
78209-0028
US

V. Phone/Fax

Practice location:
  • Phone: 956-795-4900
  • Fax: 956-726-2632
Mailing address:
  • Phone: 210-567-3274
  • Fax: 210-567-2844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GINNY LYNN GOMEZ-LEON
Title or Position: SENIOR EXECUTIVE VP & CHIEF OPERATI
Credential:
Phone: 210-450-4621