Provider Demographics
NPI:1861691818
Name:LONGORIA, DAVID ISAAC (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ISAAC
Last Name:LONGORIA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 REMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-3930
Mailing Address - Country:US
Mailing Address - Phone:956-316-1600
Mailing Address - Fax:956-383-8986
Practice Address - Street 1:212 REMINGTON AVE
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-3930
Practice Address - Country:US
Practice Address - Phone:956-316-1600
Practice Address - Fax:956-383-8986
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23289122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist