1265730915 NPI number — DENTAL AGUILA S DE RL DE CV

Table of content: (NPI 1265730915)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265730915 NPI number — DENTAL AGUILA S DE RL DE CV

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENTAL AGUILA S DE RL DE CV
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:
1265730915
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
476 S. BIBB ST.
Provider Second Line Business Mailing Address:
STE C 525
Provider Business Mailing Address City Name:
EAGLE PASS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78852
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-421-3348
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AV. 16 DE SEPTIEMBRE 335 LOCAL 9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PIEDRAS NEGROS
Provider Business Practice Location Address State Name:
COAHUILA
Provider Business Practice Location Address Postal Code:
26010
Provider Business Practice Location Address Country Code:
MX
Provider Business Practice Location Address Telephone Number:
528787820206
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/04/2011

Additional Information

Authorized Official

Authorized Official Last Name:
VILLALOBUS
Authorized Official First Name:
ROUL
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
830-421-3348

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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