Provider Demographics
NPI:1821368507
Name:TEXAS KIDS DENTAL CARE OF MONTANA VISTA, PA.
Entity Type:Organization
Organization Name:TEXAS KIDS DENTAL CARE OF MONTANA VISTA, PA.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:PORRAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-855-0948
Mailing Address - Street 1:3650 JOE BATTLE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-2628
Mailing Address - Country:US
Mailing Address - Phone:915-855-0948
Mailing Address - Fax:
Practice Address - Street 1:3650 JOE BATTLE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-2628
Practice Address - Country:US
Practice Address - Phone:915-855-0948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24362122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty