Provider Demographics
NPI:1013137082
Name:DENTAL WATERFILL SC
Entity Type:Organization
Organization Name:DENTAL WATERFILL SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:
Authorized Official - Last Name:FEUCHTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:01152656-682-0118
Mailing Address - Street 1:1120 WILL RAND DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-7620
Mailing Address - Country:US
Mailing Address - Phone:915-449-8589
Mailing Address - Fax:915-833-8796
Practice Address - Street 1:445 SABOROSA AVE
Practice Address - Street 2:
Practice Address - City:SABAROSA
Practice Address - State:CHIH
Practice Address - Zip Code:32550
Practice Address - Country:MX
Practice Address - Phone:01152656-682-0117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2988099122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty