Provider Demographics
NPI:1871831743
Name:ABC FAMILY DENTAL CARE
Entity Type:Organization
Organization Name:ABC FAMILY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAUDIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-548-0222
Mailing Address - Street 1:4430 E 14TH ST UNIT C
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-3364
Mailing Address - Country:US
Mailing Address - Phone:956-548-0222
Mailing Address - Fax:956-548-0224
Practice Address - Street 1:4430 E 14TH ST UNIT C
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-3364
Practice Address - Country:US
Practice Address - Phone:956-548-0222
Practice Address - Fax:956-548-0224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18445122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty