Provider Demographics
NPI:1982057576
Name:PEBBLE HILLS DENTAL CARE
Entity type:Organization
Organization Name:PEBBLE HILLS DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEETU
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGOO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-396-0109
Mailing Address - Street 1:11680 PEBBLE HILLS BLVD
Mailing Address - Street 2:101 AND 102
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-1090
Mailing Address - Country:US
Mailing Address - Phone:915-201-2555
Mailing Address - Fax:915-845-9746
Practice Address - Street 1:11680 PEBBLE HILLS BLVD
Practice Address - Street 2:101 AND 102
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-1090
Practice Address - Country:US
Practice Address - Phone:915-201-2555
Practice Address - Fax:915-845-9746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-19
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX305381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty