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
—
—
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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