Star Mountain Family Dental PLLC
Dentist, General Practice in El Paso, TX. Organization (NPI-2).
NPI number1164074829
StatusActive
Last updated in NPPESJun 13, 2024
Details
- NPI
- 1164074829
- Entity type
- Organization (NPI-2)
- Legal business name
- Star Mountain Family Dental PLLC
- Organization subpart
- No
- Enumeration date
- Jul 12, 2019
- Certification date
- Jun 13, 2024
- Last updated
- Jun 13, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | – | – | Yes |
| 122300000X | Dentist | – | – |
Practice location
11601 Pellicano DrEl Paso, TX 79936-6279
Phone 915-594-4048
Mailing address
11601 Pellicano DrEl Paso, TX 79936-6279
Phone 915-594-4048
Authorized official
Jacquelyn Luera
Owner
9155944048
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