Provider Demographics
NPI:1558741553
Name:PARAISO DENTAL PLLC
Entity Type:Organization
Organization Name:PARAISO DENTAL PLLC
Other - Org Name:PARAISO DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUIKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-783-7070
Mailing Address - Street 1:6708 W.MILE 7 RD.
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574
Mailing Address - Country:US
Mailing Address - Phone:956-783-7070
Mailing Address - Fax:956-781-7000
Practice Address - Street 1:1618 N VETERANS BLVD SUITE A
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589
Practice Address - Country:US
Practice Address - Phone:706-461-1631
Practice Address - Fax:956-781-7000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental