Provider Demographics
NPI:1568901957
Name:OFELIA PEREZ HERNANDEZ DDS PLLC
Entity Type:Organization
Organization Name:OFELIA PEREZ HERNANDEZ DDS PLLC
Other - Org Name:GALLERIA DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OFELIA
Authorized Official - Middle Name:P
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:956-581-5265
Mailing Address - Street 1:PO BOX 3749
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78573
Mailing Address - Country:US
Mailing Address - Phone:402-321-3632
Mailing Address - Fax:956-581-5299
Practice Address - Street 1:8360 W. EXPY 83
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572
Practice Address - Country:US
Practice Address - Phone:956-581-5265
Practice Address - Fax:956-581-5299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28024122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX365175401Medicaid
TX365175401Medicaid