Provider Demographics
NPI:1114240363
Name:DE LA GARZA, JAVIER O (DDS, PA)
Entity Type:Individual
Prefix:DR
First Name:JAVIER
Middle Name:O
Last Name:DE LA GARZA
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 E. 6TH ST.
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596
Mailing Address - Country:US
Mailing Address - Phone:956-968-8713
Mailing Address - Fax:956-973-9649
Practice Address - Street 1:901 E 6TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-4202
Practice Address - Country:US
Practice Address - Phone:956-968-8713
Practice Address - Fax:956-973-9649
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice