Provider Demographics
NPI:1508259706
Name:PROFESSIONAL DENTAL GROUP P.A.
Entity Type:Organization
Organization Name:PROFESSIONAL DENTAL GROUP P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:IRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRERA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:956-782-6767
Mailing Address - Street 1:1002 W SAM HOUSTON BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-5198
Mailing Address - Country:US
Mailing Address - Phone:956-782-6767
Mailing Address - Fax:956-782-6768
Practice Address - Street 1:1002 W SAM HOUSTON BLVD STE 6
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-5198
Practice Address - Country:US
Practice Address - Phone:956-782-6767
Practice Address - Fax:956-782-6768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-12
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22574122300000X
TX28917122300000X
TX29092122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty