Provider Demographics
NPI:1629409586
Name:ADVANCED ORTHODONTICS AND ORAL SURGERY OF LAREDO
Entity Type:Organization
Organization Name:ADVANCED ORTHODONTICS AND ORAL SURGERY OF LAREDO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:956-791-2266
Mailing Address - Street 1:6801 MCPHERSON RD STE 104
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6403
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6801 MCPHERSON RD STE 104
Practice Address - Street 2:SUITE 104
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6403
Practice Address - Country:US
Practice Address - Phone:956-791-2266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty