Provider Demographics
NPI:1366206112
Name:AMERICA DENTAL CLINIC LLC
Entity type:Organization
Organization Name:AMERICA DENTAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:HUGO
Authorized Official - Last Name:JUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-752-0686
Mailing Address - Street 1:PO BOX 5866
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78853-5866
Mailing Address - Country:US
Mailing Address - Phone:830-752-0686
Mailing Address - Fax:
Practice Address - Street 1:269 N CEYLON ST
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-4807
Practice Address - Country:US
Practice Address - Phone:830-752-0686
Practice Address - Fax:866-211-8139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental