Healthcare Provider Details

I. General information

NPI: 1467686279
Provider Name (Legal Business Name): AMERICAN DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2009
Last Update Date: 05/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ZARAGOZA Y MEXICO STE 1
PUERTO PALOMAS CHIHUAHUA
31830
MX

IV. Provider business mailing address

PO BOX 12385
EL PASO TX
79913-0385
US

V. Phone/Fax

Practice location:
  • Phone: 011526566660101
  • Fax:
Mailing address:
  • Phone: 915-449-8589
  • Fax: 915-996-9913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3841436
License Number StateZZ

VIII. Authorized Official

Name: OSCAR D PEREZ
Title or Position: OWNER
Credential:
Phone: 915-449-8589