Provider Demographics
NPI:1902970981
Name:TREVINO, JESUS HECTOR JR (DDS)
Entity Type:Individual
Prefix:MR
First Name:JESUS
Middle Name:HECTOR
Last Name:TREVINO
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:413 W SAM HOUSTON BLVD
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-5349
Mailing Address - Country:US
Mailing Address - Phone:956-781-8880
Mailing Address - Fax:956-781-8977
Practice Address - Street 1:413 W SAM HOUSTON BLVD
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-5349
Practice Address - Country:US
Practice Address - Phone:956-781-8880
Practice Address - Fax:956-781-8977
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX200281223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144922505Medicaid