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Organization
RODEO LAREDO DENTAL & ORTHODONTICS, PLLC
Active
Organization
RODEO LAREDO DENTAL & ORTHODONTICS, PLLC
Active
Other names
Rodeo Dental and Orthodontics
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RAFFY KOUYOUMDJIAN DMD (OWNER)
(972) 814-2708
Entity
Organization
Contact information
Practice address
910 GUADALUPE ST STE A, LAREDO, TX 78040-5280
(817) 529-8151
Mailing address
910 GUADALUPE STREET, SUITE A, LAREDO, TX 78040-5280
(817) 529-8151
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
182419510
—
TX
05
—
182419511
—
TX
05
—
182419513
—
TX
05
—
182419514
—
TX
05
—
182419515
—
TX
Enumeration date
06/22/2016
Last updated
02/20/2017
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