Provider Demographics
NPI:1730525692
Name:UNITED ORTHODONTICS OF SOUTH EAST EL PASO PLLC
Entity type:Organization
Organization Name:UNITED ORTHODONTICS OF SOUTH EAST EL PASO PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:361-442-4902
Mailing Address - Street 1:7878 GATEWAY BLVD. N
Mailing Address - Street 2:STE 300
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79915
Mailing Address - Country:US
Mailing Address - Phone:915-595-1200
Mailing Address - Fax:915-590-9708
Practice Address - Street 1:17503 LA CANTERA PKWY
Practice Address - Street 2:STE 104-496
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-8207
Practice Address - Country:US
Practice Address - Phone:210-561-2400
Practice Address - Fax:210-561-2400
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITED ORTHODONTICS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-20
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX236771223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty