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General NPI Number Information
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NPI Number | 1790044501
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Entity Type | Organization
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Legal Business Name | FAMILY DENTALAND, P.A.
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Dates
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Enumeration Date | 05/14/2012
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Last Update Date | 05/14/2012
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Provider Practice Location Address
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Address Line | 3401 W. MILE 5 ROAD SUITE 3
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City | MISSION
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State | TX
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Zip | 78574
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Country | US
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Telephone | 956-583-2077
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Fax | 956-583-2272
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Provider Business Mailing Address
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Address Line | 3401 W. MILE 5 ROAD SUITE 3
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City | MISSION
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State | TX
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Zip | 78574
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Country | US
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Telephone | 956-583-2077
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Fax | 956-583-2272
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MIGUEL E MEGO
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Credential | D.D.S., M.S.
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Telephone | 956-928-0022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 25382
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License Number State | TX
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