=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326172834
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. ROEL GARZA AND ASSOCIATES FAMILY DENTISTRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 750 COYOTE TRL
-----------------------------------------------------
City | ALICE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78332-4004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-668-3384
-----------------------------------------------------
Fax | 361-668-6191
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 750 COYOTE TRL
-----------------------------------------------------
City | ALICE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78332-4004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-668-3384
-----------------------------------------------------
Fax | 361-668-6191
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ROEL GARZA
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 361-668-3384
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 17020
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------