Provider Demographics
NPI:1093112310
Name:EEA INTERNATIONAL INC
Entity Type:Organization
Organization Name:EEA INTERNATIONAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:PABLO
Authorized Official - Last Name:ENG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-482-0200
Mailing Address - Street 1:2005 E GRIFFIN PKWY
Mailing Address - Street 2:SUITE 141
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572
Mailing Address - Country:US
Mailing Address - Phone:956-271-0658
Mailing Address - Fax:956-242-4583
Practice Address - Street 1:2005 E GRIFFIN PKWY SUITE 141
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572
Practice Address - Country:US
Practice Address - Phone:956-271-0658
Practice Address - Fax:956-242-4583
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EEA INTERNATIONAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty