Provider Demographics
NPI:1134979727
Name:956 DENTAL
Entity type:Organization
Organization Name:956 DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:ALFONSO
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS
Authorized Official - Phone:956-286-5674
Mailing Address - Street 1:7550 COUNTRY CLUB DR APT 10104
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-3252
Mailing Address - Country:US
Mailing Address - Phone:956-286-5674
Mailing Address - Fax:
Practice Address - Street 1:3311 E DEL MAR BLVD STE 102
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-2449
Practice Address - Country:US
Practice Address - Phone:956-508-2480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2024-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental