Provider Demographics
NPI:1851626683
Name:WESLACO PEDIATRIC DENRISTRY
Entity Type:Organization
Organization Name:WESLACO PEDIATRIC DENRISTRY
Other - Org Name:NO
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MEGO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:956-686-5511
Mailing Address - Street 1:1330 E 6TH ST STE 301
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-6608
Mailing Address - Country:US
Mailing Address - Phone:956-854-4146
Mailing Address - Fax:956-854-4116
Practice Address - Street 1:1330 E 6TH ST STE 301
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6608
Practice Address - Country:US
Practice Address - Phone:956-854-4146
Practice Address - Fax:956-854-4116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-13
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX221161223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty