Provider Demographics
NPI:1265910178
Name:TEXAS KIDS DENTAL CARE WEST PA
Entity type:Organization
Organization Name:TEXAS KIDS DENTAL CARE WEST PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:PORRAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-858-6868
Mailing Address - Street 1:7480 REMCON
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912
Mailing Address - Country:US
Mailing Address - Phone:915-852-5060
Mailing Address - Fax:915-852-3300
Practice Address - Street 1:7480 REMCON
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912
Practice Address - Country:US
Practice Address - Phone:915-852-5060
Practice Address - Fax:915-852-3300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-02
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty