Provider Demographics
NPI:1952794083
Name:MID VALLEY DENTAL GROUP, PLLC
Entity Type:Organization
Organization Name:MID VALLEY DENTAL GROUP, PLLC
Other - Org Name:DENTAL CARE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:956-968-9762
Mailing Address - Street 1:1124 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-7152
Mailing Address - Country:US
Mailing Address - Phone:956-968-9762
Mailing Address - Fax:956-968-8570
Practice Address - Street 1:1124 E 8TH ST
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-7152
Practice Address - Country:US
Practice Address - Phone:956-968-9762
Practice Address - Fax:956-968-8570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-13
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX154091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178906703Medicaid