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General NPI Number Information
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NPI Number | 1821094228
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Entity Type | Individual
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Provider Name | WENDY LYNN LARA DDS
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Gender | Female
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Dates
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Enumeration Date | 06/22/2005
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 3932 FORT BLVD
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City | EL PASO
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State | TX
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Zip | 79930-6208
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Country | US
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Telephone | 915-566-9415
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Fax |
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Provider Business Mailing Address
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Address Line | 255 HWY 187 PO BOX 370
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City | HATCH
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State | NM
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Zip | 87937-0370
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Country | US
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Telephone | 575-267-3280
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Fax | 575-267-1747
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30661
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DD2498
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License Number State | NM
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