Provider Demographics
NPI:1811430929
Name:RIO VISTA DENTISTRY, PLLC
Entity type:Organization
Organization Name:RIO VISTA DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:956-425-7726
Mailing Address - Street 1:802 S LOOP 499 STE 1
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-2519
Mailing Address - Country:US
Mailing Address - Phone:956-425-7726
Mailing Address - Fax:956-428-6822
Practice Address - Street 1:802 S LOOP 499 STE 1
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-2519
Practice Address - Country:US
Practice Address - Phone:956-425-7726
Practice Address - Fax:956-428-6822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
TX202411223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty