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	122300000X	Dentist

General Provider Information

NPI Number	:	1679905624
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERSHING FAMILY DENTAL, PC

Provider Business Mailing 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	:	915-257-6501

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	:	915-257-6501

Authorized Official
Title or Position	:	OWNER
Name	:	DEL GREENHALGH
Credential	:	DMD
Telephone Number	:	915-566-3927

Provider Enumeration Date	:	08/01/2013
Last Update Date	:	08/01/2013

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