Provider Demographics
NPI:1710232665
Name:BORDER DENTAL BILLING LLC
Entity Type:Organization
Organization Name:BORDER DENTAL BILLING LLC
Other - Org Name:LUIS M TREVINO
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:MIGUEL
Authorized Official - Last Name:TREVINO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:956-523-8701
Mailing Address - Street 1:110 CARDINAL LN
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-4150
Mailing Address - Country:US
Mailing Address - Phone:956-523-8701
Mailing Address - Fax:956-523-8701
Practice Address - Street 1:SANTOS DEGOLLADO 3343
Practice Address - Street 2:
Practice Address - City:NUEVO LAREDO
Practice Address - State:TAMAULIPAS
Practice Address - Zip Code:88240
Practice Address - Country:MX
Practice Address - Phone:956-242-4147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUIS M TREVINO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ3395326122300000X, 1223X0400X, 305R00000X
ZZ3291593122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No305R00000XManaged Care OrganizationsPreferred Provider OrganizationGroup - Multi-Specialty