Provider Demographics
NPI:1720681471
Name:TOOTH DENTAL CENTER PA
Entity Type:Organization
Organization Name:TOOTH DENTAL CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:ELMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOYA-FONSECA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-627-2385
Mailing Address - Street 1:3609 N WARE RD
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-3304
Mailing Address - Country:US
Mailing Address - Phone:956-627-2385
Mailing Address - Fax:
Practice Address - Street 1:3609 N WARE RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-3304
Practice Address - Country:US
Practice Address - Phone:956-627-2385
Practice Address - Fax:956-627-2473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-17
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1720681471OtherNPI