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General NPI Number Information
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NPI Number | 1477295210
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Entity Type | Organization
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Legal Business Name | TOOTHDAY AT W. MAIN AVE., PLLC
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Dates
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Enumeration Date | 04/12/2022
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Last Update Date | 04/12/2022
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Provider Practice Location Address
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Address Line | 1315 W MAIN AVE STE 10
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City | ALTON
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State | TX
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Zip | 78573-1643
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Country | US
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Telephone | 956-683-1600
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Fax |
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Provider Business Mailing Address
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Address Line | 4800 S 23RD ST STE 11
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City | MCALLEN
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State | TX
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Zip | 78503-8694
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Country | US
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Telephone | 956-683-1600
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | SHARON GARZA
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Credential |
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Telephone | 817-706-8189
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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