12900 EASTLAKE PLLC — NPI 1376314096 (Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) in EL PASO, TX)

CMS-1500 Box 24J / 33a • NPI

1376314096

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

1223G0001X (CMS C5)

Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)

Box 32 Service Location & ZIP+4

12900 EASTLAKE BLVD, EL PASO, TX, 79928

Official NPPES Practice Location

Practice Phone & Referral Fax

(915) 219-4713

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1376314096 (12900 EASTLAKE PLLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1376314096` (NPI-2 Organization / Facility)
Provider / Legal Name	12900 EASTLAKE PLLC
Plain-English Specialty	Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) NUCC Code: `1223G0001X` (Dentist, General Practice)
Certifying / Licensing Body	American Dental Association (ADA) / State Board of Dental Examiners
Practice Location Address	12900 EASTLAKE BLVD, EL PASO, TX, 79928
Practice Telephone / Fax	Tel: (915) 219-4713
Administrative Mailing Address	10510 MONTWOOD DR STE B, EL PASO, TX, 79935-2717
Enumeration & Last Sync	Enumerated: 2024-01-11 \| CMS Record Updated: 2024-01-11
Authorized Official	CASIE GARCIA (Billing Operation)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

12900 EASTLAKE BLVD, EL PASO, TX, 79928

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Plain-English Taxonomy & CMS Crosswalk (1223G0001X)

What Does Taxonomy Code 1223G0001X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 1223G0001X translates to:
"Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)"

CMS-1500 Medicare Specialty Crosswalk: CMS Code C5 (Dentist)
Certifying / Accrediting Authority: American Dental Association (ADA) / State Board of Dental Examiners
Clinical Scope: Routine 6-month dental checkups, toothache, dental abscess, bleeding gums (periodontitis), or wisdom tooth extraction.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (12900 EASTLAKE PLLC)

Typical CPT / Diagnostic Procedures:

Comprehensive Oral Evaluation, Digital Dental Radiographs & Prophylaxis
Restorative Composite Fillings, Crowns, Endodontic Root Canal & Extractions

Common Therapeutic Classes:

Amoxicillin, Metronidazole & Clindamycin (Odontogenic Infections)
Chlorhexidine Gluconate 0.12% Oral Rinse & High-Fluoride Varnish

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`1223G0001X` — Dentist, General Practice Plain English: Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

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12900 EASTLAKE PLLC (NPI #1376314096)