Provider Demographics
NPI:1043907702
Name:RED SQUARE DENTAL & ORTHODONTICS AT CLOSNER PLLC
Entity type:Organization
Organization Name:RED SQUARE DENTAL & ORTHODONTICS AT CLOSNER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VLADISLAV
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:LOSHKAREV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:956-686-5511
Mailing Address - Street 1:2702 CORNERSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-8327
Mailing Address - Country:US
Mailing Address - Phone:956-686-5511
Mailing Address - Fax:
Practice Address - Street 1:1615 S CLOSNER BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-5718
Practice Address - Country:US
Practice Address - Phone:956-686-5511
Practice Address - Fax:956-686-9955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty