MEDICARE: PFD EL PASO 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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1861188542
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PFD EL PASO PLLC

Provider Business Mailing Address
First Line	:	10510 MONTWOOD DR STE B
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79935-2717
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3501 PERSHING DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79903-2731
Country	:	US
Telephone Number	:	915-598-7264
Fax Number	:	915-493-6146

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	HEATHER CORDOVA
Credential	:
Telephone Number	:	915-490-8698

Provider Enumeration Date	:	04/14/2023
Last Update Date	:	04/14/2023

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Directions to “PFD EL PASO PLLC ” Practice Location

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