Provider Demographics
NPI:1114541372
Name:FV DENTA PLLC
Entity Type:Organization
Organization Name:FV DENTA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:VERA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:915-444-2567
Mailing Address - Street 1:10670 N. LOOP DR.
Mailing Address - Street 2:
Mailing Address - City:SOCORRO
Mailing Address - State:TX
Mailing Address - Zip Code:79927
Mailing Address - Country:US
Mailing Address - Phone:915-444-2567
Mailing Address - Fax:949-537-7137
Practice Address - Street 1:10670 N. LOOP DR.
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:TX
Practice Address - Zip Code:79927
Practice Address - Country:US
Practice Address - Phone:915-444-2567
Practice Address - Fax:949-537-7137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty