Provider Demographics
NPI:1770225252
Name:ACEVEDO, ADAM LEON AQUINDE (DDS)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:LEON AQUINDE
Last Name:ACEVEDO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 GEORGE DIETER DR APT 709
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7670
Mailing Address - Country:US
Mailing Address - Phone:408-718-3992
Mailing Address - Fax:
Practice Address - Street 1:2260 N ZARAGOZA RD STE A112
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-8125
Practice Address - Country:US
Practice Address - Phone:915-308-1868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-13
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX397431223G0001X
NMTD-00-153390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes1223G0001XDental ProvidersDentistGeneral Practice