Provider Demographics
NPI:1326445180
Name:IMAGINE ORTHODONTICS OF LAREDO
Entity Type:Organization
Organization Name:IMAGINE ORTHODONTICS OF LAREDO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:SALINAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-832-7825
Mailing Address - Street 1:7807 MCPHERSON RD
Mailing Address - Street 2:STE 205
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-2813
Mailing Address - Country:US
Mailing Address - Phone:956-267-8502
Mailing Address - Fax:956-267-8498
Practice Address - Street 1:7807 MCPHERSON RD
Practice Address - Street 2:STE 205
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-2813
Practice Address - Country:US
Practice Address - Phone:956-267-8502
Practice Address - Fax:956-267-8498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX265541223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty