Organization
ORAL AND CRANIOFACIAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LIZETTE ZAPATA (OFFICE MANAGER)
(956) 627-3556
Entity
Organization
Contact information
Practice address
2405 CORNERSTONE BLVD, EDINBURG, TX 78539
(956) 627-3556
(956) 627-3762
Mailing address
2405 CORNERSTONE BLVD, EDINBURG, TX 78539
(956) 627-3556
(956) 627-3762
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
18868
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
218275002
MEDICAID DENTAL TPI
TX
05
—
218275002
—
TX
01
—
218275003
CHSCN
TX
Enumeration date
09/14/2010
Last updated
11/19/2011
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