MEDICARE: JASVINDER BADWALZ DMD PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1407588593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JASVINDER BADWALZ DMD PLLC

Provider Business Mailing Address
First Line	:	1421 N LEE TREVINO DR STE D10
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-6434
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1421 N LEE TREVINO DR STE D10
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-6434
Country	:	US
Telephone Number	:	915-593-1328
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. JASVINDER BADWALZ
Credential	:
Telephone Number	:	916-747-8534

Provider Enumeration Date	:	06/27/2022
Last Update Date	:	06/27/2022

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