Organization · NPI-2

12900 Eastlake PLLC

Dentist, General Practice · El Paso, TX

NPI number1376314096
StatusActive
Last updated in NPPESJan 11, 2024

Details

NPI
1376314096
Entity type
Organization (NPI-2)
Legal business name
12900 Eastlake PLLC
Organization subpart
No
Enumeration date
Jan 11, 2024
Certification date
Jan 9, 2024
Last updated
Jan 11, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223G0001X Dentist, General Practice––Yes

Practice location

12900 Eastlake Blvd
El Paso, TX 79928

Phone 915-219-4713

Mailing address

10510 Montwood Dr Ste B
El Paso, TX 79935-2717

Phone 915-219-4713

Authorized official

Casie Garcia
Billing Operation
9152194713

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