=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467275172
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUPLED OCCLUSION, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2024
-----------------------------------------------------
Last Update Date | 11/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1508 S LONE STAR WAY STE 3
-----------------------------------------------------
City | EDINBURG
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78539-3603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-687-6103
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4121 N 22ND ST
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78504-4141
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-225-6446
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LAURO TIJERINA
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 956-225-6446
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NULL
-----------------------------------------------------