| 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 |
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