Provider Demographics
NPI:1770396798
Name:EL PASO PELLICANO FAMILY DENTISTRY
Entity type:Organization
Organization Name:EL PASO PELLICANO FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASVINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:BADWALZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:916-747-8534
Mailing Address - Street 1:10039 DYER ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-4136
Mailing Address - Country:US
Mailing Address - Phone:915-759-7000
Mailing Address - Fax:
Practice Address - Street 1:10039 DYER ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-4136
Practice Address - Country:US
Practice Address - Phone:915-759-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty