1093946329 NPI number — SAINT PAUL GENERAL DENTISTRY P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093946329 NPI number — SAINT PAUL GENERAL DENTISTRY P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAINT PAUL GENERAL DENTISTRY P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093946329
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1519 E BUSTAMANTE ST STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAREDO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78041-5305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-795-1010
Provider Business Mailing Address Fax Number:
956-795-1040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1519 E BUSTAMANTE ST STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAREDO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78041-5305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-795-1010
Provider Business Practice Location Address Fax Number:
956-795-1040
Provider Enumeration Date:
08/04/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SALAZAR
Authorized Official First Name:
ROLANDO
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
956-795-1010

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  21354 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223X0400X , with the licence number: 21354 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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