Provider Demographics
NPI:1679050751
Name:PECOS DENTAL PC
Entity type:Organization
Organization Name:PECOS DENTAL PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABHISHEK
Authorized Official - Middle Name:
Authorized Official - Last Name:RUPARELIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-445-3333
Mailing Address - Street 1:800 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PECOS
Mailing Address - State:TX
Mailing Address - Zip Code:79772-2917
Mailing Address - Country:US
Mailing Address - Phone:432-445-3333
Mailing Address - Fax:
Practice Address - Street 1:800 W 3RD ST
Practice Address - Street 2:
Practice Address - City:PECOS
Practice Address - State:TX
Practice Address - Zip Code:79772-2917
Practice Address - Country:US
Practice Address - Phone:432-445-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty