Provider Demographics
NPI:1164680955
Name:GRUPO ODONTOLOGICO ESPECIALIZADO
Entity Type:Organization
Organization Name:GRUPO ODONTOLOGICO ESPECIALIZADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ CHIRINO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:01152656-623-7067
Mailing Address - Street 1:651 VAL VERDE ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-5009
Mailing Address - Country:US
Mailing Address - Phone:915-373-2751
Mailing Address - Fax:
Practice Address - Street 1:MANUEL GOMEZ MORIN NO. 7497-4
Practice Address - Street 2:FRACC. RINCONES DE SAN MARCOS
Practice Address - City:CD. JUAREZ
Practice Address - State:CHIHUAHUA
Practice Address - Zip Code:32500
Practice Address - Country:MX
Practice Address - Phone:01152656-623-7067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental