Provider Demographics
NPI:1710259650
Name:AGUILERA LASER DENTAL
Entity Type:Organization
Organization Name:AGUILERA LASER DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:UBALDO
Authorized Official - Last Name:AGUILERA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:956-827-2636
Mailing Address - Street 1:425 E COMA AVE
Mailing Address - Street 2:SUITE 315
Mailing Address - City:HIDALGO
Mailing Address - State:TX
Mailing Address - Zip Code:78557-2508
Mailing Address - Country:US
Mailing Address - Phone:956-827-2636
Mailing Address - Fax:
Practice Address - Street 1:AVE. MIGUEL ALEMAN 1125
Practice Address - Street 2:ZONA CENTRO
Practice Address - City:REYNOSA
Practice Address - State:TAMAULIPAS
Practice Address - Zip Code:88510
Practice Address - Country:MX
Practice Address - Phone:01152899-922-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ52853641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty