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General NPI Number Information
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NPI Number | 1134613441
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Entity Type | Organization
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Legal Business Name | CARDENAS DENTAL IMPLANTS AND ORAL SURGERY
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Dates
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Enumeration Date | 06/20/2018
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Last Update Date | 02/11/2020
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Provider Practice Location Address
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Address Line | 2121 PEASE ST STE 314
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City | HARLINGEN
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State | TX
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Zip | 78550-8349
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Country | US
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Telephone | 956-216-7570
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Fax | 956-216-7571
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Provider Business Mailing Address
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Address Line | 2121 PEASE ST STE 314
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City | HARLINGEN
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State | TX
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Zip | 78550-8349
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Country | US
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Telephone | 956-216-7570
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Fax | 956-216-7571
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Authorized Official
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Title or Position | MANAGER/PRESIDENT
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Name | DR. OMEL GERARDO CARDENAS
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Credential | DDS
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Telephone | 956-216-7570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 20431
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License Number State | TX
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