Provider Demographics
NPI:1669085650
Name:FAVELA, HORACIO JR (DDS)
Entity type:Individual
Prefix:DR
First Name:HORACIO
Middle Name:
Last Name:FAVELA
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5877 ACACIA CIR APT 1218
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-4877
Mailing Address - Country:US
Mailing Address - Phone:915-204-1903
Mailing Address - Fax:
Practice Address - Street 1:2625 MCNUTT RD
Practice Address - Street 2:
Practice Address - City:SUNLAND PARK
Practice Address - State:NM
Practice Address - Zip Code:88063-9608
Practice Address - Country:US
Practice Address - Phone:575-589-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD53121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice