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General NPI Number Information
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NPI Number | 1538498571
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Entity Type | Organization
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Legal Business Name | BROWNSVILLE PEDIATRIC DENTISTRY
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Dates
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Enumeration Date | 12/22/2009
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Last Update Date | 12/22/2009
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Provider Practice Location Address
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Address Line | 2155 N EXPRESSWAY SUITE H
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City | BROWNSVILLE
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State | TX
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Zip | 78520-9828
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Country | US
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Telephone | 210-315-6405
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Fax |
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Provider Business Mailing Address
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Address Line | 9813 SANDHILL UNIT 39
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City | LAREDO
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State | TX
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Zip | 78045-8872
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Country | US
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Telephone | 210-542-2699
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | DR. LORENA DELGADO SALCEDO
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Credential | D.D.S., M.S.
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Telephone | 210-542-2699
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 20983
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License Number State | TX
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