| Professional Dental Group P.a. | |
|
1115 Professional Dr Brownsville TX 78520-6462 | |
| (956) 782-6767 | |
| Not Available |
| Full Name | Professional Dental Group P.a. |
|---|---|
| Speciality | Dentist |
| Location | 1115 Professional Dr, Brownsville, Texas |
| Authorized Official Name and Position | Iris Barrera (PRESIDENT) |
| Authorized Official Contact | 9567826767 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Professional Dental Group P.a. 1115 Professional Dr Brownsville TX 78520-6462 Ph: (956) 782-6767 | Professional Dental Group P.a. 1115 Professional Dr Brownsville TX 78520-6462 Ph: (956) 782-6767 |
| NPI Number | 1851643134 |
|---|---|
| Provider Enumeration Date | 10/10/2012 |
| Last Update Date | 10/10/2012 |
| Medicare PECOS PAC ID | 3476968132 |
|---|---|
| Medicare Enrollment ID | O20210211000701 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851643134 | NPI | - | NPPES |
| 1779188-03 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 22574 (Texas) | Primary |
| Provider Name | Iris Barrera |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1265531289 PECOS PAC ID: 4385059047 Enrollment ID: I20210211002237 |
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