1730415324 NPI number — FAMILY DENTAL CARE CLINIC

Table of content: (NPI 1730415324)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730415324 NPI number — FAMILY DENTAL CARE CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY DENTAL CARE CLINIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730415324
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 CANYON SPRINGS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-760-6234
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HERMANOS ESCOBAR Y LINCOLN #201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CD JUAREZ
Provider Business Practice Location Address State Name:
CHIH
Provider Business Practice Location Address Postal Code:
32310
Provider Business Practice Location Address Country Code:
MX
Provider Business Practice Location Address Telephone Number:
011526566165689
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/02/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NUNEZ
Authorized Official First Name:
BERTHA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
915-760-6234

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  5137963 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)