Provider Demographics
NPI:1417480369
Name:BORDER DENTAL CENTER DE NUEVO LAREDO SC
Entity Type:Organization
Organization Name:BORDER DENTAL CENTER DE NUEVO LAREDO SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLANUEVA
Authorized Official - Suffix:
Authorized Official - Credentials:MDS
Authorized Official - Phone:956-645-9738
Mailing Address - Street 1:1806 COMMERCE DR STE 203
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-2884
Mailing Address - Country:US
Mailing Address - Phone:956-645-9738
Mailing Address - Fax:
Practice Address - Street 1:SANTOS DEGOLLADO 2229
Practice Address - Street 2:COLONIA GUERRERO
Practice Address - City:NUEVO LAREDO
Practice Address - State:TAMAULIPAS
Practice Address - Zip Code:88240
Practice Address - Country:MX
Practice Address - Phone:956-242-4144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-07
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ1150654261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental