MEDICARE: MOUNTAIN VIEW DENTAL

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	20772	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235514696
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN VIEW DENTAL

Provider Business Mailing Address
First Line	:	7700 ALABAMA ST
Second Line	:	SUITE A
City	:	EL PASO
State	:	TX
Zip	:	79904-3161
Country	:	US
Telephone Number	:	915-545-5453
Fax Number	:	915-544-2572

Provider Business Practice Location Address
First Line	:	10978 MONTWOOD DR
Second Line	:	SUITE B
City	:	EL PASO
State	:	TX
Zip	:	79935-3053
Country	:	US
Telephone Number	:	915-545-5453
Fax Number	:	915-544-2572

Authorized Official
Title or Position	:	GENERAL DENTIST
Name	:	DR. NOEMI VARGAS
Credential	:	D.M.D
Telephone Number	:	915-544-2572

Provider Enumeration Date	:	07/28/2015
Last Update Date	:	07/28/2015

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Directions to “MOUNTAIN VIEW DENTAL ” Practice Location

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