Provider Demographics
NPI:1265698906
Name:VICTORIA FAMILY DENTISTRY
Entity type:Organization
Organization Name:VICTORIA FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HEARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-575-4508
Mailing Address - Street 1:107 PROFESSIONAL PARK DR.
Mailing Address - Street 2:VICTORIA FAMILY DENTISTRY
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:107 PROFESSIONAL PARK DR.
Practice Address - Street 2:VICTORIA FAMILY DENTISTRY
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904
Practice Address - Country:US
Practice Address - Phone:361-575-4508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19166122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty