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General NPI Number Information
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NPI Number | 1285096982
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Entity Type | Organization
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Legal Business Name | BROWNSVILLE SMILE CENTER PLLC
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 03/22/2016
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Provider Practice Location Address
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Address Line | 100 UPTOWN AVE 100 B
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City | BROWNSVILLE
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State | TX
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Zip | 78520-7559
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Country | US
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Telephone | 956-572-0049
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Fax |
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Provider Business Mailing Address
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Address Line | 100 UPTOWN AVE 100 B
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City | BROWNSVILLE
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State | TX
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Zip | 78520-7559
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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. CRYSTAL VILLARREAL
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Credential | DDS
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Telephone | 956-572-0049
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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 | 30016
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30290
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License Number State | TX
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