Provider Demographics
NPI:1356849053
Name:HECTOR CARLOS TIJERINA DDS PLLC
Entity Type:Organization
Organization Name:HECTOR CARLOS TIJERINA DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:TIJERINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-954-5307
Mailing Address - Street 1:11100 PARKFIELD DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-4263
Mailing Address - Country:US
Mailing Address - Phone:210-954-5307
Mailing Address - Fax:
Practice Address - Street 1:11100 PARKFIELD DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-4263
Practice Address - Country:US
Practice Address - Phone:210-954-5307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-28
Last Update Date:2018-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28039261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental