Provider Demographics
NPI:1821362195
Name:EL PASO SMILES CENTER, PLLC
Entity Type:Organization
Organization Name:EL PASO SMILES CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALDANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-533-3435
Mailing Address - Street 1:615 E SCHUSTER AVE
Mailing Address - Street 2:BLDG. 5
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4350
Mailing Address - Country:US
Mailing Address - Phone:915-533-3435
Mailing Address - Fax:915-533-3784
Practice Address - Street 1:615 E SCHUSTER AVE
Practice Address - Street 2:BLDG. 5
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4350
Practice Address - Country:US
Practice Address - Phone:915-533-3435
Practice Address - Fax:915-533-3784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171719102Medicaid