Provider Demographics
NPI:1659693570
Name:NUNEZ, GRACIELA V (MDS)
Entity Type:Individual
Prefix:DR
First Name:GRACIELA
Middle Name:V
Last Name:NUNEZ
Suffix:
Gender:F
Credentials:MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 JORDAN DR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-9126
Mailing Address - Country:US
Mailing Address - Phone:956-242-4144
Mailing Address - Fax:
Practice Address - Street 1:SANTOS DEGOLLADO 2229
Practice Address - Street 2:COL. GUERRERO
Practice Address - City:NUEVO LAREDO
Practice Address - State:TAMAULIPAS
Practice Address - Zip Code:88240
Practice Address - Country:MX
Practice Address - Phone:867-715-1405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ1150654122300000X
ZZ36246921223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics