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Organization
TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER
Active
Organization
TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEVEN M. WAGNER (MANAGING DIRECTOR)
(915) 594-3584
Entity
Organization
Contact information
Practice address
4801 ALBERTA AVE, EL PASO, TX 79905-2707
(915) 215-5300
Mailing address
P.O. BOX 9520, EL PASO, TX 79995-9520
(915) 594-3582
(915) 594-3589
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
NULL
122300000X
Dentist
—
—
1223P0221X
Pediatric Dentistry
—
NULL
1223P0221X
Pediatric Dentistry
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
0012562
TX
Other
Enumeration date
10/22/2010
Last updated
06/17/2019
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