Provider Demographics
NPI:1326290701
Name:FD SERVICE
Entity Type:Organization
Organization Name:FD SERVICE
Other - Org Name:FD SERVICE DBA AMIRA CARMONA DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARMONA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:956-727-0497
Mailing Address - Street 1:4619 SAN DARIO AVE # 224
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-5773
Mailing Address - Country:US
Mailing Address - Phone:956-727-0497
Mailing Address - Fax:
Practice Address - Street 1:HEROE DE NACATAZ # 2111 ALTOS
Practice Address - Street 2:
Practice Address - City:NUEVO LAREDO
Practice Address - State:TAMPS
Practice Address - Zip Code:88000
Practice Address - Country:MX
Practice Address - Phone:867-713-1314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ3139088261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental