Provider Demographics
NPI:1497240535
Name:AM INTEGRATIVE DENTAL CARE OF EL PASO PC
Entity Type:Organization
Organization Name:AM INTEGRATIVE DENTAL CARE OF EL PASO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-779-6403
Mailing Address - Street 1:5939 GATEWAY BLVD W STE B
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-3301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5939 GATEWAY BLVD W STE B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-3301
Practice Address - Country:US
Practice Address - Phone:915-779-6403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty