MEDICARE: DR. JUAN A VERASTEGUI DDS

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	36490	TX

General Provider Information

NPI Number	:	1841801586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN A VERASTEGUI DDS

Provider Business Mailing Address
First Line	:	12261 EASTLAKE BLVD STE E507
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79928-7800
Country	:	US
Telephone Number	:	915-205-3500
Fax Number	:	915-205-3510

Provider Business Practice Location Address
First Line	:	12261 EASTLAKE BLVD STE E507
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79928-7800
Country	:	US
Telephone Number	:	915-205-3500
Fax Number	:	915-205-3510

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2020
Last Update Date	:	09/20/2024

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