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NPI Code Detail

MEDICARE: EL PASO PELLICANO FAMILY DENTISTRY

MEDICARE: EL PASO PELLICANO FAMILY DENTISTRY
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
11223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1235904632
Entity Type Code : Organization
Provider Name (Legal Business Name) : EL PASO PELLICANO FAMILY DENTISTRY
Provider Business Mailing Address
First Line : 1920 N ZARAGOZA RD STE 107
Second Line :
City : EL PASO
State : TX
Zip : 79938-4656
Country : US
Telephone Number : 915-856-1771
Fax Number : 915-856-1772
Provider Business Practice Location Address
First Line : 1920 N ZARAGOZA RD STE 107
Second Line :
City : EL PASO
State : TX
Zip : 79938-4656
Country : US
Telephone Number : 915-856-1771
Fax Number : 915-856-1772
Authorized Official
Title or Position : OWNER/DENTIST
Name : DR. JASVINDER BADWALZ
Credential : DDS
Telephone Number : 916-747-8534
Provider Enumeration Date : 11/16/2023
Last Update Date : 11/16/2023

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Directions to “EL PASO PELLICANO FAMILY DENTISTRY ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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