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General NPI Number Information
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NPI Number | 1477356228
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Entity Type | Organization
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Legal Business Name | LEGACY SMILES EDINBURG PLLC
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Dates
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Enumeration Date | 03/28/2025
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Last Update Date | 03/28/2025
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Provider Practice Location Address
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Address Line | 4626 S CLOSNER BLVD
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City | EDINBURG
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State | TX
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Zip | 78539-7279
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Country | US
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Telephone | 956-475-3005
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Fax |
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Provider Business Mailing Address
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Address Line | 4626 S CLOSNER BLVD
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City | EDINBURG
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State | TX
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Zip | 78539-7279
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Country | US
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Telephone | 956-475-3005
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | JERIN JACOB
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Credential |
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Telephone | 956-574-4666
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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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