12900 Eastlake PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

12900 EASTLAKE PLLC

Practice address

12900 Eastlake Blvd
El Paso, TX 79928

Phone

(915) 219-4713

NPI assigned

Jan 11, 2024

Last updated

Jan 11, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Casie Garcia

Title

Billing Operation

Phone

(915) 219-4713

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1704931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704931200000",
    "number": "1376314096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10510 MONTWOOD DR STE B",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799352717",
            "telephone_number": "915-219-4713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12900 EASTLAKE BLVD",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "79928",
            "telephone_number": "915-219-4713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "12900 EASTLAKE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-11",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-09",
        "status": "A",
        "authorized_official_last_name": "GARCIA",
        "authorized_official_first_name": "CASIE",
        "authorized_official_title_or_position": "BILLING OPERATION",
        "authorized_official_telephone_number": "915-219-4713"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in El Paso, TX
• Providers in El Paso, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.