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Organization
VALLEY DENTAL PA
Active
Organization
VALLEY DENTAL PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WENDELL DAVID DDS (DIRECT OWNER)
(956) 546-2973
Entity
Organization
Contact information
Practice address
2334 BOCA CHICA BLVD, SUITE #200, BROWNSVILLE, TX 78521-2230
(956) 546-2973
(956) 546-1342
Mailing address
2334 BOCA CHICA BLVD, SUITE #200, BROWNSVILLE, TX 78521-2230
(956) 546-2973
(956) 546-1342
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
162986701
—
TX
01
—
G60109-6
TEXAS CHIP PROVIDER NUMBE
TX
Enumeration date
09/29/2006
Last updated
09/11/2014
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