Provider Demographics
NPI:1073609053
Name:RIOS, TARA REGINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:REGINA
Last Name:RIOS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 E ALTON GLOOR BLVD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-3831
Mailing Address - Country:US
Mailing Address - Phone:956-542-1956
Mailing Address - Fax:
Practice Address - Street 1:1601 E ALTON GLOOR BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-3902
Practice Address - Country:US
Practice Address - Phone:956-542-1956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXB19175122300000X
TX191751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111235104Medicaid
TX111235106Medicaid