Provider Demographics
NPI:1639532005
Name:ADVANCED DENTISTRY & HEADACHE CENTER
Entity Type:Organization
Organization Name:ADVANCED DENTISTRY & HEADACHE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:ALEJANDRA
Authorized Official - Last Name:ZARATE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:956-627-5047
Mailing Address - Street 1:2309 N 10TH STREET
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-4403
Mailing Address - Country:US
Mailing Address - Phone:956-627-5047
Mailing Address - Fax:956-627-4956
Practice Address - Street 1:2309 N 10TH STREET
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-4403
Practice Address - Country:US
Practice Address - Phone:956-627-5047
Practice Address - Fax:956-627-4956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-01
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22787122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1870768Medicaid