Provider Demographics
NPI:1184879579
Name:E. P. DENTISTRY 4 KIDS 1, PLLC
Entity type:Organization
Organization Name:E. P. DENTISTRY 4 KIDS 1, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:LEACH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:915-751-0123
Mailing Address - Street 1:1502 NORTH ZARAGOSA ROAD
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936
Mailing Address - Country:US
Mailing Address - Phone:915-855-4442
Mailing Address - Fax:915-313-7960
Practice Address - Street 1:1502 NORTH ZARAGOSA ROAD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936
Practice Address - Country:US
Practice Address - Phone:915-855-4442
Practice Address - Fax:915-313-7960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-26
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX237111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty