Provider Demographics
NPI:1568132926
Name:COURRECH MARTIN, MA ELENA (DDS, MS)
Entity Type:Individual
Prefix:
First Name:MA ELENA
Middle Name:
Last Name:COURRECH MARTIN
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 S VILLA REAL DR
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-6749
Mailing Address - Country:US
Mailing Address - Phone:727-204-2842
Mailing Address - Fax:
Practice Address - Street 1:101 E EXPRESSWAY 83 STE 120
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-1164
Practice Address - Country:US
Practice Address - Phone:956-215-7060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX378871223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics