Organization
COMMUNITY DENTAL OUTREACH, PLLC
Active
Other names
Imagine Dental of South Laredo
Organization subpart
No
Provider details
NPI number
Authorized official
BRADLEY RICHENS DDS (OWNER)
(972) 832-7825
Entity
Organization
Contact information
Practice address
3507 JAIME ZAPATA MEMORIAL HWY STE 3, LAREDO, TX 78043-4769
(972) 832-7825
Mailing address
3507 JAIME ZAPATA MEMORIAL HWY STE 3, LAREDO, TX 78043-4769
(972) 832-7825
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
06/25/2013
Last updated
06/25/2013
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