Provider Demographics
NPI:1124549555
Name:SABAL DENTAL AIRLINE PLLC
Entity Type:Organization
Organization Name:SABAL DENTAL AIRLINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:956-428-3300
Mailing Address - Street 1:2319 E TYLER AVE
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-7384
Mailing Address - Country:US
Mailing Address - Phone:956-428-3300
Mailing Address - Fax:
Practice Address - Street 1:2222 AIRLINE RD STE A4
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-2644
Practice Address - Country:US
Practice Address - Phone:361-853-8999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-07
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty