MEDICARE: EP DENTAL PLLC

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

General Provider Information

NPI Number	:	1356730188
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EP DENTAL PLLC

Provider Business Mailing Address
First Line	:	15110 DALLAS PKWY
Second Line	:	SUITE 470
City	:	DALLAS
State	:	TX
Zip	:	75248-4635
Country	:	US
Telephone Number	:	972-512-0285
Fax Number	:

Provider Business Practice Location Address
First Line	:	6232 GATEWAY BLVD E
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79905-2005
Country	:	US
Telephone Number	:	972-512-0285
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SARABJIT KHASSA
Credential	:
Telephone Number	:	972-512-0285

Provider Enumeration Date	:	01/16/2015
Last Update Date	:	01/16/2015

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Directions to “EP DENTAL PLLC ” Practice Location

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