Provider Demographics
NPI:1235904632
Name:EL PASO PELLICANO FAMILY DENTISTRY
Entity Type:Organization
Organization Name:EL PASO PELLICANO FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASVINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:BADWALZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-747-8534
Mailing Address - Street 1:1920 N ZARAGOZA RD STE 107
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-4656
Mailing Address - Country:US
Mailing Address - Phone:915-856-1771
Mailing Address - Fax:915-856-1772
Practice Address - Street 1:1920 N ZARAGOZA RD STE 107
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-4656
Practice Address - Country:US
Practice Address - Phone:915-856-1771
Practice Address - Fax:915-856-1772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty