MEDICARE: PERSHING FAMILY DENTAL, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	25959	TX

General Provider Information

NPI Number	:	1093112450
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERSHING FAMILY DENTAL, PC

Provider Business Mailing Address
First Line	:	10510 MONTWOOD DR
Second Line	:	SUITE B
City	:	EL PASO
State	:	TX
Zip	:	79935-2703
Country	:	US
Telephone Number	:	915-778-4681
Fax Number	:

Provider Business Practice Location Address
First Line	:	3501 PERSHING DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79903-2731
Country	:	US
Telephone Number	:	915-566-3927
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATION
Name	:	RACHEL GREENHALGH
Credential	:
Telephone Number	:	915-778-4681

Provider Enumeration Date	:	12/01/2014
Last Update Date	:	02/23/2015

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