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General NPI Number Information
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NPI Number | 1720681471
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Entity Type | Organization
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Legal Business Name | TOOTH DENTAL CENTER PA
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Dates
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Enumeration Date | 11/17/2020
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Last Update Date | 11/22/2022
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Provider Practice Location Address
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Address Line | 3609 N WARE RD
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City | MCALLEN
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State | TX
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Zip | 78501-3304
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Country | US
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Telephone | 956-627-2385
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Fax | 956-627-2473
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Provider Business Mailing Address
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Address Line | 3609 N WARE RD
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City | MCALLEN
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State | TX
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Zip | 78501-3304
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Country | US
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Telephone | 956-627-2385
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Fax |
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Authorized Official
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Title or Position | CO-SUPERVISOR
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Name | ELMA MOYA-FONSECA
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Credential |
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Telephone | 956-627-2385
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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