Provider Demographics
NPI:1699280792
Name:RAQUEL B KIRWIN DMD PLLC
Entity type:Organization
Organization Name:RAQUEL B KIRWIN DMD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:BAAMONDE
Authorized Official - Last Name:KIRWIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:915-249-2298
Mailing Address - Street 1:12040 TIERRA ESTE RD STE B212
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-4672
Mailing Address - Country:US
Mailing Address - Phone:915-249-2298
Mailing Address - Fax:915-249-4160
Practice Address - Street 1:12040 TIERRA ESTE RD STE B212
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-4672
Practice Address - Country:US
Practice Address - Phone:915-249-2298
Practice Address - Fax:915-249-4160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-11
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30359261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental