Provider Demographics
NPI:1144739475
Name:UNITED DENTISTRY OF FAR EAST EL PASO
Entity Type:Organization
Organization Name:UNITED DENTISTRY OF FAR EAST EL PASO
Other - Org Name:BLISS FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-274-7071
Mailing Address - Street 1:3201 CHERRY RIDGE ST STE A101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-4824
Mailing Address - Country:US
Mailing Address - Phone:915-849-9400
Mailing Address - Fax:
Practice Address - Street 1:1971 N ZARAGOZA RD STE A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-7992
Practice Address - Country:US
Practice Address - Phone:915-849-9400
Practice Address - Fax:915-849-1983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-29
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty