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General NPI Number Information
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NPI Number | 1689827933
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Entity Type | Organization
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Legal Business Name | MAXILLOFACIAL PROSTHETICS & IMPLANT DENTISTRY PC
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Dates
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Enumeration Date | 10/30/2008
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Last Update Date | 10/30/2008
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Provider Practice Location Address
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Address Line | 5529 N MCCOLL RD
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City | MCALLEN
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State | TX
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Zip | 78504-2244
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Country | US
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Telephone | 956-630-2702
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Fax | 956-630-2703
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Provider Business Mailing Address
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Address Line | 5529 N MCCOLL RD
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City | MCALLEN
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State | TX
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Zip | 78504-2244
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Country | US
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Telephone | 956-630-2702
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Fax | 956-630-2703
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Authorized Official
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Title or Position | DDS MSD
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Name | DR. DOMINGO VALADEZ
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Credential | DDS MSD
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Telephone | 956-630-2702
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 16880
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License Number State | TX
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