# FV DENTA PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Kids Dental & Orthodontics
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114541372
- **Authorized official:** EDWARD LEE VERA DMD (OWNER-DENTIST)
- **Authorized official phone:** (915) 444-2567

## Contact information

- **Practice address:** 10670 N. LOOP DR., SOCORRO, TX 79927
- **Practice address phone:** (915) 444-2567
- **Practice address fax:** (949) 537-7137
- **Mailing address:** 10670 N. LOOP DR., SOCORRO, TX 79927
- **Mailing address phone:** (915) 444-2567
- **Mailing address fax:** (949) 537-7137

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | Yes |
| 1223P0221X | Pediatric Dentistry | — | — | — |

## Other

- **Enumeration date:** 06/03/2020
- **Last updated:** 06/03/2020