Provider Demographics
NPI:1255453858
Name:AMIGO CHILDREN'S DENTAL, PA
Entity type:Organization
Organization Name:AMIGO CHILDREN'S DENTAL, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:HULEN
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-391-1775
Mailing Address - Street 1:300 W NICHOLSON ST
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-5923
Mailing Address - Country:US
Mailing Address - Phone:210-391-1775
Mailing Address - Fax:
Practice Address - Street 1:606 N BEDELL AVE
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-4109
Practice Address - Country:US
Practice Address - Phone:210-391-1775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206631223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty