Provider Demographics
NPI:1053432005
Name:VALLEY FAMILY DENTISTRY ASSOCIATES, P. A.
Entity type:Organization
Organization Name:VALLEY FAMILY DENTISTRY ASSOCIATES, P. A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:LANDEROS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:956-423-0191
Mailing Address - Street 1:1724 N ED CAREY DR STE B
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8202
Mailing Address - Country:US
Mailing Address - Phone:956-423-0191
Mailing Address - Fax:953-423-7907
Practice Address - Street 1:1724 N ED CAREY DR, SUITE B
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8202
Practice Address - Country:US
Practice Address - Phone:956-423-0191
Practice Address - Fax:953-423-7907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty