Provider Demographics
NPI:1811561293
Name:TEXAS TECH UNIVERSITY HSC AT EL WLH SCHOOL OF DENTAL MEDICINE
Entity Type:Organization
Organization Name:TEXAS TECH UNIVERSITY HSC AT EL WLH SCHOOL OF DENTAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DEAN OF CLINICAL AFFAIRS
Authorized Official - Prefix:DR
Authorized Official - First Name:FADY
Authorized Official - Middle Name:
Authorized Official - Last Name:FADDOUL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:915-215-4579
Mailing Address - Street 1:5001 EL PASO DRIVE, MSC 24002
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:222 RICK FRANCIS ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2817
Practice Address - Country:US
Practice Address - Phone:915-215-6700
Practice Address - Fax:915-215-4726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty