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Organization
LAREDO COVENANT DENTAL, P.A.
Active
Organization
LAREDO COVENANT DENTAL, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JIN M LEE D.D.S. (OWNER)
(956) 712-8444
Entity
Organization
Contact information
Practice address
7917 MCPHERSON RD, SUITE 202, LAREDO, TX 78045-2811
(956) 712-8444
(956) 712-8439
Mailing address
7917 MCPHERSON RD, SUITE 202, LAREDO, TX 78045-2811
(956) 712-8444
(956) 712-8439
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
21524
TX
1223G0001X
General Practice Dentistry
Primary
21577
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G-6003101
TEXAS CHIP
TX
Enumeration date
08/22/2006
Last updated
08/22/2020
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