Provider Demographics
NPI:1346638558
Name:FIRST FAMILY DENTAL GROUP
Entity Type:Organization
Organization Name:FIRST FAMILY DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENECHUKWU
Authorized Official - Middle Name:
Authorized Official - Last Name:EZE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:888-439-6661
Mailing Address - Street 1:3700 HUECO VALLEY DR
Mailing Address - Street 2:#104
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-5408
Mailing Address - Country:US
Mailing Address - Phone:888-439-6661
Mailing Address - Fax:
Practice Address - Street 1:3590 N ZARAGOZA
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936
Practice Address - Country:US
Practice Address - Phone:888-439-6661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX258201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty