Provider Demographics
NPI:1477864478
Name:VALLEY ORTHODONTICS & DENTOFACIAL ORTHOPEDICS, P.A.
Entity Type:Organization
Organization Name:VALLEY ORTHODONTICS & DENTOFACIAL ORTHOPEDICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:956-783-9595
Mailing Address - Street 1:1203 N RAUL LONGORIA RD STE K
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-3742
Mailing Address - Country:US
Mailing Address - Phone:956-783-9595
Mailing Address - Fax:956-783-9519
Practice Address - Street 1:1203 N RAUL LONGORIA RD STE K
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-3742
Practice Address - Country:US
Practice Address - Phone:956-783-9595
Practice Address - Fax:956-783-9519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX132731223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty