Provider Demographics
NPI:1578060943
Name:TONGCO, IRISH ABIGAIL MARTINEZ (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:IRISH ABIGAIL
Middle Name:MARTINEZ
Last Name:TONGCO
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:3200 MCKINNEY AVE APT 405
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-2544
Mailing Address - Country:US
Mailing Address - Phone:321-297-5208
Mailing Address - Fax:
Practice Address - Street 1:3201 WESTERN CENTER BLVD STE 115
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-7135
Practice Address - Country:US
Practice Address - Phone:872-578-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX337791223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics