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General NPI Number Information
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NPI Number | 1679817183
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Entity Type | Organization
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Legal Business Name | RIO GRANDE CITY PEDIATRIC DENTISTRY PLLC
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Dates
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Enumeration Date | 11/21/2012
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Last Update Date | 11/26/2012
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Provider Practice Location Address
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Address Line | 5342 E US HIGHWAY 83 BLDG C SUITE # 3
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City | RIO GRANDE CITY
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State | TX
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Zip | 78582-9431
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Country | US
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Telephone | 956-317-1365
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Fax | 956-317-1367
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Provider Business Mailing Address
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Address Line | 5342 E US HIGHWAY 83 BLDG C SUITE # 3
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City | RIO GRANDE CITY
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State | TX
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Zip | 78582-9431
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Country | US
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Telephone | 956-317-1365
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Fax | 956-317-1367
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Authorized Official
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Title or Position | OWNER
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Name | DR. VLADISLAV V LOSHKAREV
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Credential | DDS
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Telephone | 956-686-5511
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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 |
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License Number State |
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