Provider Demographics
NPI:1861167207
Name:ANCIRA FAMILY DENTAL
Entity type:Organization
Organization Name:ANCIRA FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ANCIRA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:956-763-2625
Mailing Address - Street 1:1601 E ALTON GLOOR BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-3972
Mailing Address - Country:US
Mailing Address - Phone:956-763-2625
Mailing Address - Fax:
Practice Address - Street 1:1601 E ALTON GLOOR BLVD STE 108
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-3972
Practice Address - Country:US
Practice Address - Phone:956-763-2625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX32501Medicaid