Provider Demographics
NPI:1548768930
Name:HONDO DENTAL PLLC
Entity Type:Organization
Organization Name:HONDO DENTAL PLLC
Other - Org Name:FIESTA DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:BOGGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-368-1495
Mailing Address - Street 1:1261 W GREEN OAKS BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-8349
Mailing Address - Country:US
Mailing Address - Phone:940-368-1495
Mailing Address - Fax:
Practice Address - Street 1:166 MENEFEE ST STE C
Practice Address - Street 2:
Practice Address - City:HONDO
Practice Address - State:TX
Practice Address - Zip Code:78861-3713
Practice Address - Country:US
Practice Address - Phone:830-426-2255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX243481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty