NPIMap

Organization Active NPI

El Paso Pellicano Family Dentistry

Doing business as Pellicano Family Dentistry

  • Dental Clinic/Center
  • El Paso, TX
National Provider Identifier
1629663356
Registry record updated Jul 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
EL PASO PELLICANO FAMILY DENTISTRY
Doing business as
Pellicano Family Dentistry
Practice address
11615 Pellicano Dr Ste 100
El Paso, TX 79936-6242
Phone
(915) 444-8006
NPI assigned
Mar 4, 2021
Last updated
Jul 26, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2022

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

Authorized official

Name
Dr. Jasvinder S Badwalz, DMD
Title
Owner
Phone
(916) 747-8534

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X NU Primary
Oral Medicine Dentistry 125Q00000X NU

Addresses

Primary practice location

11615 Pellicano Dr Ste 100
El Paso, TX 79936-6242

Mailing address

11615 Pellicano Dr Ste 100
El Paso, TX 79936-6242
Phone (915) 444-8006

Other names 1

  • Pellicano Family Dentistry Doing business as

National Provider Directory

National Provider Directory
Tax ID family
El Paso Pellicano Family Dentistry4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1614816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658793600000",
    "number": "1629663356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11615 PELLICANO DR STE 100",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799366242",
            "telephone_number": "915-444-8006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11615 PELLICANO DR STE 100",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799366242",
            "telephone_number": "915-444-8006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EL PASO PELLICANO FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-04",
        "last_updated": "2022-07-26",
        "certification_date": "2022-07-26",
        "status": "A",
        "authorized_official_last_name": "BADWALZ",
        "authorized_official_first_name": "JASVINDER",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "916-747-8534",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "125Q00000X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pellicano Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pellicano Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in El Paso, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2022; 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.