# TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER

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

## Provider details

- **NPI number:** 1659671824
- **Authorized official:** MR. STEVEN M. WAGNER (MANAGING DIRECTOR)
- **Authorized official phone:** (915) 594-3584

## Contact information

- **Practice address:** 4801 ALBERTA AVE, EL PASO, TX 79905-2707
- **Practice address phone:** (915) 215-5300
- **Mailing address:** P.O. BOX 9520, EL PASO, TX 79995-9520
- **Mailing address phone:** (915) 594-3582
- **Mailing address fax:** (915) 594-3589

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | — |
| 122300000X | Dentist | — | — | — |
| 1223P0221X | Pediatric Dentistry | — | NULL | — |
| 1223P0221X | Pediatric Dentistry | — | — | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 0012562 | TX | Yes |

## Other

- **Enumeration date:** 10/22/2010
- **Last updated:** 06/17/2019