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General NPI Number Information
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NPI Number | 1609093939
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Entity Type | Organization
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Legal Business Name | ORTHOGENESIS INTERNATIONAL CENTRE SOUTH, PA
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 12/05/2012
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Provider Practice Location Address
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Address Line | 6410 MCPHERSON RD SUITE 2
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City | LAREDO
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State | TX
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Zip | 78041-6191
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Country | US
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Telephone | 956-717-9877
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Fax | 956-717-9881
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Provider Business Mailing Address
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Address Line | 6410 MCPHERSON RD SUITE 2
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City | LAREDO
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State | TX
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Zip | 78041-6191
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Country | US
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Telephone | 956-717-9877
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Fax | 956-717-9881
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NELIA PATRICIA GARCIA-MORALES
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Credential | DDS, MSD
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Telephone | 956-717-9877
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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 | 20718
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 20718
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License Number State | TX
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