Healthcare Provider Details

I. General information

NPI: 1083854509
Provider Name (Legal Business Name): RGV DENTAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2009
Last Update Date: 02/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 N DICK DOWLING ST
SAN BENITO TX
78586-5219
US

IV. Provider business mailing address

995 N DICK DOWLING ST
SAN BENITO TX
78586-5219
US

V. Phone/Fax

Practice location:
  • Phone: 956-399-1889
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. VALERIE DRAKE
Title or Position: PRESIDENT
Credential: DDS
Phone: 956-399-1889