Healthcare Provider Details

I. General information

NPI: 1699260190
Provider Name (Legal Business Name): LAURO TIJERINA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4121 N 22ND ST
MCALLEN TX
78504-4141
US

IV. Provider business mailing address

4121 N 22ND ST
MCALLEN TX
78504-4141
US

V. Phone/Fax

Practice location:
  • Phone: 956-687-6103
  • Fax:
Mailing address:
  • Phone: 956-687-6103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number34050
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: