Provider Demographics
NPI:1477295210
Name:TOOTHDAY AT W. MAIN AVE., PLLC
Entity type:Organization
Organization Name:TOOTHDAY AT W. MAIN AVE., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-706-8189
Mailing Address - Street 1:4800 S 23RD ST STE 11
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-8694
Mailing Address - Country:US
Mailing Address - Phone:956-683-1600
Mailing Address - Fax:
Practice Address - Street 1:1315 W MAIN AVE STE 10
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:TX
Practice Address - Zip Code:78573-1643
Practice Address - Country:US
Practice Address - Phone:956-683-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty