Provider Demographics
NPI:1669159869
Name:PALOMITA DENTAL LLC
Entity type:Organization
Organization Name:PALOMITA DENTAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ABREFI-KETE ASARE
Authorized Official - Middle Name:
Authorized Official - Last Name:ASARE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-903-7044
Mailing Address - Street 1:2702 ANEJO DR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-6480
Mailing Address - Country:US
Mailing Address - Phone:817-903-7044
Mailing Address - Fax:
Practice Address - Street 1:3210 JAIME ZAPATA HWY
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043
Practice Address - Country:US
Practice Address - Phone:956-727-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-29
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty