Provider Demographics
NPI:1043727415
Name:FV DENTAL, PLLC
Entity Type:Organization
Organization Name:FV DENTAL, PLLC
Other - Org Name:KIDS DENTAL & ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:VERA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:915-444-2567
Mailing Address - Street 1:10670 NORTH LOOP DR.
Mailing Address - Street 2:
Mailing Address - City:SOCORRO
Mailing Address - State:TX
Mailing Address - Zip Code:79927
Mailing Address - Country:US
Mailing Address - Phone:915-444-2567
Mailing Address - Fax:949-537-7137
Practice Address - Street 1:10670 NORTH LOOP DR
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:TX
Practice Address - Zip Code:79927
Practice Address - Country:US
Practice Address - Phone:915-444-2567
Practice Address - Fax:949-537-7137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-06
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX296461223G0001X
1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty