1972632123 NPI number — ELISABETH IRENE ROWOLD-GARCIAMENDEZ D.D.S., M.S.

Table of content: ELISABETH IRENE ROWOLD-GARCIAMENDEZ D.D.S., M.S. (NPI 1972632123)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972632123 NPI number — ELISABETH IRENE ROWOLD-GARCIAMENDEZ D.D.S., M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROWOLD-GARCIAMENDEZ
Provider First Name:
ELISABETH
Provider Middle Name:
IRENE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.D.S., M.S.
Provider Gender Code:
F

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:
1972632123
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
335 N ALLEN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75013-2539
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-727-0011
Provider Business Mailing Address Fax Number:
972-727-0707

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
335 N ALLEN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75013-2539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-727-0011
Provider Business Practice Location Address Fax Number:
972-727-0707
Provider Enumeration Date:
03/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  18425 , 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)

  • Identifier: 0000ZBX696 . This is a "BCBS OF MA ID#" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 900-53478 . This is a "BCBS OF ALABAMA ID#" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 75288660401011 . This is a "BCBS OF UTAH ID#" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 861423 . This is a "UNITED CONCORDIA ID #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 85D713 . This is a "BCBS OF TEXAS PROVIDER #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com