Provider Demographics
NPI:1407324288
Name:MEDEL PRACTICE MANAGEMENT
Entity Type:Organization
Organization Name:MEDEL PRACTICE MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:903-292-5115
Mailing Address - Street 1:729 W 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75110-2942
Mailing Address - Country:US
Mailing Address - Phone:903-872-6685
Mailing Address - Fax:
Practice Address - Street 1:729 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-2942
Practice Address - Country:US
Practice Address - Phone:903-292-5115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NICHOLAS A MEDEL DDS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty