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General NPI Number Information
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NPI Number | 1982973616
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Entity Type | Organization
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Legal Business Name | THE CHILDREN'S DENTIST
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Dates
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Enumeration Date | 12/27/2011
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Last Update Date | 12/27/2011
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Provider Practice Location Address
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Address Line | 1717 E HARRISON AVE
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City | HARLINGEN
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State | TX
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Zip | 78550-7389
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Country | US
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Telephone | 956-428-2221
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Fax | 956-423-4492
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Provider Business Mailing Address
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Address Line | 1717 E HARRISON AVE
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City | HARLINGEN
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State | TX
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Zip | 78550-7389
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Country | US
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Telephone | 956-428-2221
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Fax | 956-423-4492
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GEORGE M ANGELOS
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Credential | DMD
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Telephone | 956-428-2221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 17313
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License Number State | TX
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