1366801821 NPI number — MC DENTAL CARE OF MISSION, PLLC

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 1366801821 NPI number — MC DENTAL CARE OF MISSION, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MC DENTAL CARE OF MISSION, PLLC
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:
1366801821
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2413 E INTERSTATE HIGHWAY 2 STE 50
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MISSION
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78572-1019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-583-5430
Provider Business Mailing Address Fax Number:
956-583-5431

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3724 PECAN BLVD STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCALLEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78501-5073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-583-5430
Provider Business Practice Location Address Fax Number:
956-583-5431
Provider Enumeration Date:
02/12/2016

Additional Information

Authorized Official

Authorized Official Last Name:
CHAVEZ
Authorized Official First Name:
MARITZA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
956-583-5430

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , 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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