MEDICARE: THE DENTAL PLACE, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	15633	TX
2	124Q00000X	Dental Hygienist	13559	TX
3	124Q00000X	Dental Hygienist	14040	TX
4	124Q00000X	Dental Hygienist	13838	TX

General Provider Information

NPI Number	:	1215030838
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE DENTAL PLACE, PC

Provider Business Mailing Address
First Line	:	213 CEDAR DR
Second Line	:	SUITE C
City	:	PORTLAND
State	:	TX
Zip	:	78374-2900
Country	:	US
Telephone Number	:	361-643-2522
Fax Number	:	361-643-1266

Provider Business Practice Location Address
First Line	:	213 CEDAR DR
Second Line	:	SUITE C
City	:	PORTLAND
State	:	TX
Zip	:	78374-2900
Country	:	US
Telephone Number	:	361-643-2522
Fax Number	:	361-643-1266

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. CARLOS V JARAMILLO
Credential	:	DDS
Telephone Number	:	361-643-2522

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	09/11/2025

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Directions to “THE DENTAL PLACE, PC ” Practice Location

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