Provider Demographics
NPI:1114304391
Name:HIDALGO FAMILY AND COSMETIC DENTISTRY
Entity Type:Organization
Organization Name:HIDALGO FAMILY AND COSMETIC DENTISTRY
Other - Org Name:HESSEN DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DURAN JR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:956-238-8207
Mailing Address - Street 1:601 S INTERNATIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:HIDALGO
Mailing Address - State:TX
Mailing Address - Zip Code:78557-2933
Mailing Address - Country:US
Mailing Address - Phone:956-843-7776
Mailing Address - Fax:956-843-7733
Practice Address - Street 1:601 S INTERNATIONAL BLVD
Practice Address - Street 2:
Practice Address - City:HIDALGO
Practice Address - State:TX
Practice Address - Zip Code:78557-2933
Practice Address - Country:US
Practice Address - Phone:956-843-7776
Practice Address - Fax:956-843-7733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24288122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty