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General NPI Number Information
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NPI Number | 1871831743
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Entity Type | Organization
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Legal Business Name | ABC FAMILY DENTAL CARE
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Dates
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Enumeration Date | 01/28/2013
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Last Update Date | 01/28/2013
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Provider Practice Location Address
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Address Line | 4430 E 14TH ST UNIT C
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City | BROWNSVILLE
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State | TX
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Zip | 78521-3364
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Country | US
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Telephone | 956-548-0222
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Fax | 956-548-0224
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Provider Business Mailing Address
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Address Line | 4430 E 14TH ST UNIT C
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City | BROWNSVILLE
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State | TX
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Zip | 78521-3364
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Country | US
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Telephone | 956-548-0222
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Fax | 956-548-0224
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | AMANDA CLAUDIO
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Credential |
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Telephone | 956-548-0222
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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 | 18445
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License Number State | TX
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