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General NPI Number Information
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NPI Number | 1679358345
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Entity Type | Organization
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Legal Business Name | IDENTIST, PLLC
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Dates
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Enumeration Date | 08/30/2023
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Last Update Date | 08/30/2023
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Provider Practice Location Address
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Address Line | 825 W DOVE AVE
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City | MCALLEN
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State | TX
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Zip | 78504-3508
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Country | US
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Telephone | 956-855-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 7600 N CYNTHIA ST
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City | MCALLEN
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State | TX
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Zip | 78504-1618
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Country | US
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Telephone | 956-369-0080
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | STEVEN LEE
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Credential | DDS
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Telephone | 956-369-0080
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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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