Provider Demographics
NPI:1831599083
Name:KIRWIN, RAQUEL BAAMONDE (DMD)
Entity type:Individual
Prefix:DR
First Name:RAQUEL
Middle Name:BAAMONDE
Last Name:KIRWIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12040 TIERRA ESTE RD STE B212
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-4672
Mailing Address - Country:US
Mailing Address - Phone:915-249-2298
Mailing Address - Fax:915-249-4160
Practice Address - Street 1:12040 TIERRA ESTE RD STE B212
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-4672
Practice Address - Country:US
Practice Address - Phone:915-249-2298
Practice Address - Fax:915-249-4160
Is Sole Proprietor?:No
Enumeration Date:2014-08-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30359122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX30359OtherLICENSE