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General NPI Number Information
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NPI Number | 1184272429
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Entity Type | Organization
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Legal Business Name | MUSTANG PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 08/29/2019
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Last Update Date | 08/30/2019
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Provider Practice Location Address
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Address Line | 204 E 2ND ST
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City | RIO GRANDE CITY
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State | TX
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Zip | 78582-3804
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Country | US
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Telephone | 956-992-1900
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5779
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City | MCALLEN
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State | TX
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Zip | 78502-5779
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | TRAVIS CORWIN
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Credential |
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Telephone | 956-992-1900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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