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General NPI Number Information
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NPI Number | 1730470618
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Entity Type | Organization
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Legal Business Name | EUTIQUIO M. ELIZONDO JR DDS PC
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Dates
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Enumeration Date | 04/26/2011
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Last Update Date | 04/26/2011
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Provider Practice Location Address
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Address Line | 100 E. EBONY LN.
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City | EDINBURG
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State | TX
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Zip | 78539
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Country | US
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Telephone | 956-380-3636
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Fax |
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Provider Business Mailing Address
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Address Line | 100 E EBONY LN
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City | EDINBURG
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State | TX
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Zip | 78539-5648
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Country | US
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Telephone | 956-380-3636
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Fax |
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Authorized Official
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Title or Position | FRONT OFFICE
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Name | MRS. NANCI DAVILA
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Credential |
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Telephone | 956-380-3636
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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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