Provider Demographics
NPI:1073505293
Name:MCFADDEN, ROBERT EMMETT (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EMMETT
Last Name:MCFADDEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 N MESA ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-5428
Mailing Address - Country:US
Mailing Address - Phone:915-584-4433
Mailing Address - Fax:915-584-2716
Practice Address - Street 1:5555 N MESA ST
Practice Address - Street 2:SUITE 100
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-5428
Practice Address - Country:US
Practice Address - Phone:915-584-4433
Practice Address - Fax:915-584-2716
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice