Healthcare Provider Details

I. General information

NPI: 1245190834
Provider Name (Legal Business Name): CARLOS NICOLAS NOWIK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2025
Last Update Date: 11/15/2025
Certification Date: 11/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10510 MONTWOOD DR
EL PASO TX
79935-2716
US

IV. Provider business mailing address

4717 HONDO PASS DR
EL PASO TX
79904-1474
US

V. Phone/Fax

Practice location:
  • Phone: 915-308-7079
  • Fax:
Mailing address:
  • Phone: 754-303-2554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number42096
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: