NPI 1376314096 · live from the CMS NPI Registry
12900 Eastlake PLLC
Dentist, General Practice in El Paso, TX. National Provider Identifier 1376314096, active.
NPI record
| NPI | 1376314096 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Dentist, General Practice 1223G0001X |
| Practice location | 12900 Eastlake Blvd, El Paso, TX 79928 |
| Practice phone | 915-219-4713 |
| Mailing address | 10510 Montwood Dr Ste B, El Paso, TX 79935 |
| Enumerated | January 11, 2024 |
| Last updated | January 11, 2024 |
| Authorized official | Casie Garcia, Billing Operation |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dentist, General Practice primary | 1223G0001X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.