# EL PASO PELLICANO FAMILY DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pellicano Family Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629663356
- **Authorized official:** DR. JASVINDER S BADWALZ DMD (OWNER)
- **Authorized official phone:** (916) 747-8534

## Contact information

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

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 125Q00000X | Oral Medicine Dentistry | — | NULL | — |
| 125Q00000X | Oral Medicine Dentistry | — | — | — |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/04/2021
- **Last updated:** 07/26/2022