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General NPI Number Information
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NPI Number | 1396825949
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Entity Type | Individual
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Provider Name | EUTIQUIO M ELIZONDO JR. DDS
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Gender | Male
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 04/05/2011
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Provider Practice Location Address
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Address Line | 100 E EBONY LANE
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City | EDINBURG
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State | TX
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Zip | 78539
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Country | US
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Telephone | 956-380-3636
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Fax | 956-316-3866
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Provider Business Mailing Address
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Address Line | 100 E EBONY LANE
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City | EDINBURG
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State | TX
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Zip | 78539
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Country | US
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Telephone | 956-380-3636
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Fax | 956-316-3866
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 742912615
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License Number State | TX
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