| Professional Associate | |
|
11165 La Quinta Place El Paso TX 79936 | |
| (915) 591-1999 | |
| (915) 591-3201 |
| Full Name | Professional Associate |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 11165 La Quinta Place, El Paso, Texas |
| Authorized Official Name and Position | Eugene Davis Stevenson (OWNER) |
| Authorized Official Contact | 9155911999 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Professional Associate 11165 La Quinta Place El Paso TX 79936 Ph: (915) 591-1999 | Professional Associate 11165 La Quinta Place El Paso TX 79936 Ph: (915) 591-1999 |
| NPI Number | 1417027251 |
|---|---|
| Provider Enumeration Date | 11/09/2006 |
| Last Update Date | 10/01/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417027251 | NPI | - | NPPES |
| D13513 | Other | BCBS | |
| 828328 | Other | UNITED CONCORDIA | |
| G601421 | Other | DELTA CHIP | |
| 111009002 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 13513 (Texas) | Primary |
Kool Smiles Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 6910 N Mesa St Ste C, El Paso, TX 79912 Phone: 800-920-9947 Fax: 678-247-7858 | |
Access Dental Of Weston Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1715 Weston Brent Ln, El Paso, TX 79935 Phone: 915-778-4545 | |
Northeast Dental Center Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 9201 Dyer St, Suite B, El Paso, TX 79924 Phone: 915-751-7070 | |
Crossroads Dental Clinic, P.a. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 8001 N Mesa St, Suite D, El Paso, TX 79932 Phone: 915-833-3232 Fax: 915-833-3283 | |
Dental Fun Zone Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 10501 Gateway Blvd W, Suite 107, El Paso, TX 79925 Phone: 915-590-4600 Fax: 915-590-4604 | |
Enrique Darancou Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 210 Thunderbird Dr Ste X, El Paso, TX 79912 Phone: 319-530-8567 | |
Reece Orthodontics Llc Dba Alamo Orthodontics Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 14021 Pebble Hills Blvd, Suite 206 And 207, El Paso, TX 79938 Phone: 435-229-0777 |