Provider Demographics
NPI:1003238825
Name:NAVARRO-PRIDA, PLCC
Entity Type:Organization
Organization Name:NAVARRO-PRIDA, PLCC
Other - Org Name:NAVARRO-PRIDA, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:YURI
Authorized Official - Last Name:PRIDA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:956-627-3446
Mailing Address - Street 1:4733 S. JACKSON RD.
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539
Mailing Address - Country:US
Mailing Address - Phone:956-627-3446
Mailing Address - Fax:956-627-3930
Practice Address - Street 1:4733 S. JACKSON RD.
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539
Practice Address - Country:US
Practice Address - Phone:956-627-3446
Practice Address - Fax:956-627-3930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX271191223G0001X
TX226621223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty