Eutiquio M Elizondo Jr., DDS

Primary specialty

DentistTaxonomy code 122300000X

License

742912615 Issued in TX

Practice address

100 E Ebony Lane
Edinburg, TX 78539

Phone

(956) 380-3636

Fax

(956) 316-3866

NPI assigned

Oct 17, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Eutiquio M. Elizondo Jr DDS PC

  • General Practice Dentistry
  • Edinburg, TX
  • NPI 1730470618
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1301961600000",
    "number": "1396825949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E EBONY LANE",
            "city": "EDINBURG",
            "state": "TX",
            "postal_code": "78539",
            "telephone_number": "956-380-3636",
            "fax_number": "956-316-3866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E EBONY LANE",
            "city": "EDINBURG",
            "state": "TX",
            "postal_code": "78539",
            "telephone_number": "956-380-3636",
            "fax_number": "956-316-3866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELIZONDO",
        "first_name": "EUTIQUIO",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2011-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "742912615",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111245001",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS CHIP",
            "identifier": "B14495",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elite Obstetrics & Gynecology of South Texas PLLC
• Elite Rehab Services, L.L.C.
• Sandra Elizama, COTA
• Anniella Elizondo
• David Elizondo, DDS.
• Oneida Elizondo, FNP
• Paola Elizondo
• Roberto Elizondo Jr., LPC
• Samantha Joy Elizondo, M.S., CCC-SLP
• Scarlet Duvessa Elizondo

• Dentist in Edinburg, TX
• Providers in Edinburg, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.