Provider Demographics
NPI:1467641357
Name:LOWER VALLEY DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:LOWER VALLEY DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:PIRTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:956-350-0059
Mailing Address - Street 1:4920 N EXPRESSWAY STE D
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-4335
Mailing Address - Country:US
Mailing Address - Phone:956-350-0059
Mailing Address - Fax:956-350-5447
Practice Address - Street 1:4920 N EXPRESSWAY STE D
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-4335
Practice Address - Country:US
Practice Address - Phone:956-350-0059
Practice Address - Fax:956-350-5447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180346201Medicaid