Provider Demographics
NPI:1871945766
Name:CULEBRA CHILDREN'S DENTAL ASSOCIATION PLLC
Entity type:Organization
Organization Name:CULEBRA CHILDREN'S DENTAL ASSOCIATION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:210-845-7070
Mailing Address - Street 1:7807 MCPHERSON RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-2813
Mailing Address - Country:US
Mailing Address - Phone:956-267-8502
Mailing Address - Fax:956-267-8498
Practice Address - Street 1:11831 CULEBRA RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-4578
Practice Address - Country:US
Practice Address - Phone:210-625-5353
Practice Address - Fax:210-625-5354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-05
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX255281223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty