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General NPI Number Information
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NPI Number | 1093112310
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Entity Type | Organization
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Legal Business Name | EEA INTERNATIONAL INC
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Dates
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Enumeration Date | 12/02/2014
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Last Update Date | 12/02/2014
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Provider Practice Location Address
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Address Line | 2005 E GRIFFIN PKWY SUITE 141
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City | MISSION
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State | TX
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Zip | 78572
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Country | US
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Telephone | 956-271-0658
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Fax | 956-242-4583
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Provider Business Mailing Address
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Address Line | 2005 E GRIFFIN PKWY SUITE 141
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City | MISSION
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State | TX
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Zip | 78572
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Country | US
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Telephone | 956-271-0658
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Fax | 956-242-4583
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. JUAN PABLO ENG
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Credential | D.D.S.
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Telephone | 619-482-0200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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