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Organization
PORT LAVACA DENTISTRY PLLC
Active
Organization
PORT LAVACA DENTISTRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAOLA LOPEZ (PAYER ENROLLMENT TEAM LEAD)
(972) 869-3789
Entity
Organization
Contact information
Practice address
1606 N VIRGINIA ST, PORT LAVACA, TX 77979
(361) 552-5800
(888) 276-1646
Mailing address
ATTN: CREDENTIALING, 2403 LACY LANE, CARROLLTON, TX 75006
(972) 869-3789
(888) 276-1646
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
27025
TX
Other
Enumeration date
05/20/2014
Last updated
12/04/2025
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