Provider Demographics
NPI:1821546888
Name:WES BRANSFORD DENTAL PC
Entity Type:Organization
Organization Name:WES BRANSFORD DENTAL PC
Other - Org Name:LEE TREVINO DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:AUGUST
Authorized Official - Last Name:CHENAUSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:915-593-8815
Mailing Address - Street 1:1624 N LEE TREVINO DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-5100
Mailing Address - Country:US
Mailing Address - Phone:915-593-8815
Mailing Address - Fax:915-593-8857
Practice Address - Street 1:1624 N LEE TREVINO DR
Practice Address - Street 2:SUITE A
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-5100
Practice Address - Country:US
Practice Address - Phone:915-593-8815
Practice Address - Fax:915-593-8857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32243261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental