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Organization
EL PASO PELLICANO FAMILY DENTISTRY
Active
Organization
EL PASO PELLICANO FAMILY DENTISTRY
Active
Other names
Pellicano Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASVINDER S BADWALZ DMD (OWNER)
(916) 747-8534
Entity
Organization
Contact information
Practice address
11615 PELLICANO DR STE 100, EL PASO, TX 79936-6242
(915) 444-8006
Mailing address
11615 PELLICANO DR STE 100, EL PASO, TX 79936-6242
(915) 444-8006
Taxonomy
Speciality
Code
Description
License number
State
125Q00000X
Oral Medicine Dentistry
—
NULL
125Q00000X
Oral Medicine Dentistry
—
—
261QD0000X
Dental Clinic/Center
Primary
—
NULL
Other
Enumeration date
03/04/2021
Last updated
07/26/2022
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