Healthcare Provider Details

I. General information

NPI: 1700773066
Provider Name (Legal Business Name): EL PASO ORAL SURGERY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2025
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11965 PELLICANO DR
EL PASO TX
79936-6852
US

IV. Provider business mailing address

2201 CIVIC CIR STE 600
AMARILLO TX
79109-1817
US

V. Phone/Fax

Practice location:
  • Phone: 915-855-2337
  • Fax:
Mailing address:
  • Phone: 806-381-3435
  • Fax: 806-353-7077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM EDWARD GRAVES
Title or Position: OWNER
Credential: DMD
Phone: 915-855-2337