Provider Demographics
NPI:1588085047
Name:MY RGV DENTIST
Entity type:Organization
Organization Name:MY RGV DENTIST
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:ERNESTO
Authorized Official - Last Name:CARREON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:956-566-6110
Mailing Address - Street 1:3819 CAMINO REAL VIEJO
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596
Mailing Address - Country:US
Mailing Address - Phone:956-472-7271
Mailing Address - Fax:
Practice Address - Street 1:COAHUILA 223
Practice Address - Street 2:SUITE #18
Practice Address - City:NUEVO PROGRESO
Practice Address - State:TAMAULIPAS
Practice Address - Zip Code:88810
Practice Address - Country:MX
Practice Address - Phone:956-566-0973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-30
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ13020181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty