Provider Demographics
NPI:1093103707
Name:MID VALLEY DENTAL GROUP PLLC
Entity Type:Organization
Organization Name:MID VALLEY DENTAL GROUP PLLC
Other - Org Name:DENTAL CARE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:956-969-2727
Mailing Address - Street 1:1124 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-7152
Mailing Address - Country:US
Mailing Address - Phone:956-969-2727
Mailing Address - Fax:956-969-8570
Practice Address - Street 1:1124 E 8TH ST
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-7152
Practice Address - Country:US
Practice Address - Phone:956-969-2727
Practice Address - Fax:956-969-8570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15409261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental