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General NPI Number Information
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NPI Number | 1265698906
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Entity Type | Organization
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Legal Business Name | VICTORIA FAMILY DENTISTRY
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Dates
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Enumeration Date | 08/01/2008
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Last Update Date | 08/01/2008
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Provider Practice Location Address
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Address Line | 107 PROFESSIONAL PARK DR. VICTORIA FAMILY DENTISTRY
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City | VICTORIA
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State | TX
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Zip | 77904
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Country | US
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Telephone | 361-575-4508
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Fax |
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Provider Business Mailing Address
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Address Line | 107 PROFESSIONAL PARK DR. VICTORIA FAMILY DENTISTRY
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City | VICTORIA
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State | TX
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Zip | 77904
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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 | DENTIST
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Name | DR. RICHARD HEARD
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Credential |
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Telephone | 361-575-4508
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 19166
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License Number State | TX
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