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General NPI Number Information
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NPI Number | 1982889556
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Entity Type | Organization
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Legal Business Name | EASTSIDE DENTAL CARE, PLLC
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Dates
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Enumeration Date | 01/02/2008
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Last Update Date | 01/02/2008
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Provider Practice Location Address
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Address Line | 1920 N ZARAGOZA RD SUITE 107
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City | EL PASO
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State | TX
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Zip | 79938-4655
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Country | US
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Telephone | 915-921-5331
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Fax | 915-921-5333
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Provider Business Mailing Address
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Address Line | 1920 N ZARAGOZA RD SUITE 107
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City | EL PASO
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State | TX
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Zip | 79938-4655
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Country | US
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Telephone | 915-921-5331
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Fax | 915-921-5333
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. PAUL SUNGHEE RO
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Credential | DDS
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Telephone | 915-799-8758
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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 | 20877
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License Number State | TX
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