1255602868 NPI number — ORTHODONTIX LTD OF WEST EL PASO, PLLC

Table of content: STEPHANIE LOUISE PALMATEER DPT (NPI 1386917136)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255602868 NPI number — ORTHODONTIX LTD OF WEST EL PASO, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHODONTIX LTD OF WEST EL PASO, PLLC
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:
6
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:
1255602868
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7500 N MESA ST STE 304
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:
79912-3512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-231-9983
Provider Business Mailing Address Fax Number:
915-231-9966

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7500 N MESA ST STE 304
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79912-3512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-231-9983
Provider Business Practice Location Address Fax Number:
915-231-9966
Provider Enumeration Date:
01/13/2012

Additional Information

Authorized Official

Authorized Official Last Name:
VONDRAK
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
915-231-9983

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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