Provider Demographics
NPI:1730470618
Name:EUTIQUIO M. ELIZONDO JR DDS PC
Entity Type:Organization
Organization Name:EUTIQUIO M. ELIZONDO JR DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT OFFICE
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCI
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-380-3636
Mailing Address - Street 1:100 E EBONY LN
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-5648
Mailing Address - Country:US
Mailing Address - Phone:956-380-3636
Mailing Address - Fax:
Practice Address - Street 1:100 E. EBONY LN.
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539
Practice Address - Country:US
Practice Address - Phone:956-380-3636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty