| Agua Dental | |
|
105 South Cesar Chavez Road Suite #2 San Juan TX 78589 | |
| (956) 380-2482 | |
| Not Available |
| Full Name | Agua Dental |
|---|---|
| Speciality | Dentist |
| Location | 105 South Cesar Chavez Road, San Juan, Texas |
| Authorized Official Name and Position | Shahrouz Akhavan (OWNER) |
| Authorized Official Contact | 9563802482 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Agua Dental 307 E University Dr Edinburg TX 78539-3549 Ph: (956) 380-2482 | Agua Dental 105 South Cesar Chavez Road Suite #2 San Juan TX 78589 Ph: (956) 380-2482 |
| NPI Number | 1811325970 |
|---|---|
| Provider Enumeration Date | 10/28/2013 |
| Last Update Date | 10/28/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811325970 | NPI | - | NPPES |
| 211344106 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 25304 (Texas) | Primary |
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