Healthcare Provider Details

I. General information

NPI: 1619039088
Provider Name (Legal Business Name): JAMES DEBOER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6955 N MESA SUITE 101
EL PASO TX
79912
US

IV. Provider business mailing address

6955 N MESA SUITE 101
EL PASO TX
79912
US

V. Phone/Fax

Practice location:
  • Phone: 915-845-7110
  • Fax: 915-885-7112
Mailing address:
  • Phone: 915-845-7110
  • Fax: 915-885-7112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number17702
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: