Provider Demographics
NPI:1831550185
Name:DE LA ROSA AND MARTINEZ DENTISTRY PLLC
Entity type:Organization
Organization Name:DE LA ROSA AND MARTINEZ DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA ROSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-399-4312
Mailing Address - Street 1:985 S SAM HOUSTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586-3064
Mailing Address - Country:US
Mailing Address - Phone:956-399-4312
Mailing Address - Fax:956-399-9337
Practice Address - Street 1:985 S SAM HOUSTON BLVD
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586-3064
Practice Address - Country:US
Practice Address - Phone:956-399-4312
Practice Address - Fax:956-399-9337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111234402Medicaid
TX198199501Medicaid
TX213449601Medicaid
TX335402901Medicaid