Individual
DR. EUTIQUIO M ELIZONDO JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
100 E EBONY LANE, EDINBURG, TX 78539
(956) 380-3636
(956) 316-3866
Mailing address
100 E EBONY LANE, EDINBURG, TX 78539
(956) 380-3636
(956) 316-3866
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
742912615
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111245001
—
TX
01
—
B14495
TEXAS CHIP
—
Enumeration date
10/17/2006
Last updated
04/05/2011
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