Provider Demographics
NPI:1629846647
Name:VICTORIA ORTHODONTIC ASSOCIATES
Entity Type:Organization
Organization Name:VICTORIA ORTHODONTIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:FRELS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:361-578-0326
Mailing Address - Street 1:203 KERH BLVD
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-1218
Mailing Address - Country:US
Mailing Address - Phone:361-578-0326
Mailing Address - Fax:361-578-7614
Practice Address - Street 1:203 KERH BLVD
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-1218
Practice Address - Country:US
Practice Address - Phone:361-578-0326
Practice Address - Fax:361-578-7614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty