Provider Demographics
NPI:1265697494
Name:MCCOLL DENTAL CENTER
Entity type:Organization
Organization Name:MCCOLL DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSI
Authorized Official - Middle Name:
Authorized Official - Last Name:MENENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-316-1582
Mailing Address - Street 1:1314 S MCCOLL RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-7989
Mailing Address - Country:US
Mailing Address - Phone:956-316-1582
Mailing Address - Fax:956-380-1176
Practice Address - Street 1:1314 S MCCOLL RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-7989
Practice Address - Country:US
Practice Address - Phone:956-316-1582
Practice Address - Fax:956-380-1176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX159671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156783601Medicaid
TXB1596701OtherCHIP DENTAL SERVICES