# PELLICANO FAMILY DENTISTRY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407413594
- **Authorized official:** LUPITA MENDOZA (OFFICE MANAGER)
- **Authorized official phone:** (214) 616-6148

## Contact information

- **Practice address:** 11615 PELLICANO DR \# 100, EL PASO, TX 79936-6242
- **Practice address phone:** (915) 444-8006
- **Mailing address:** 11615 PELLICANO DR \# 100, EL PASO, TX 79936-6242
- **Mailing address phone:** (915) 444-8006

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 05/23/2019
- **Last updated:** 05/23/2019