Provider Demographics
NPI:1124397245
Name:AA RELAX DENTAL CARE P.L.L.C.
Entity Type:Organization
Organization Name:AA RELAX DENTAL CARE P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:915-400-2150
Mailing Address - Street 1:7020 ESPANOLA LN
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-1514
Mailing Address - Country:US
Mailing Address - Phone:915-400-2150
Mailing Address - Fax:
Practice Address - Street 1:7211 N MESA ST STE 3E
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-3607
Practice Address - Country:US
Practice Address - Phone:915-400-2150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25508122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty