=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639532005
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED DENTISTRY & HEADACHE CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/01/2016
-----------------------------------------------------
Last Update Date | 02/03/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2309 N 10TH STREET
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78501-4403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-627-5047
-----------------------------------------------------
Fax | 956-627-4956
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2309 N 10TH STREET
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78501-4403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-627-5047
-----------------------------------------------------
Fax | 956-627-4956
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST/OWNER
-----------------------------------------------------
Name | DR. ERIKA ALEJANDRA ZARATE
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 956-627-5047
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 22787
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------