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General NPI Number Information
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NPI Number | 1487871711
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Entity Type | Organization
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Legal Business Name | LOS EBANOS FAMILY DENTISTRY
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 925 E LOS EBANOS BLVD
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City | BROWNSVILLE
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State | TX
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Zip | 78520-8726
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Country | US
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Telephone | 956-542-1177
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Fax | 956-542-0033
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Provider Business Mailing Address
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Address Line | 925 E LOS EBANOS BLVD
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City | BROWNSVILLE
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State | TX
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Zip | 78520-8726
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Country | US
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Telephone | 956-542-1177
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Fax | 956-542-0033
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Authorized Official
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Title or Position | DENTIST
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Name | DR. LILLIAN ADAME NELSON
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Credential | DDS
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Telephone | 956-542-1177
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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 | 18988
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 21228
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 22054
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License Number State | TX
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