Basic Information
| Provider Information | |||||||||
| NPI: | 1669613485 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FURCHTGOTT | ||||||||
| FirstName: | NATASHA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10175 GATEWAY BLVD W STE 304 | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799257618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155046880 | ||||||||
| FaxNumber: | 9155998579 | ||||||||
| Practice Location | |||||||||
| Address1: | 10175 GATEWAY BLVD W STE 304 | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155046880 | ||||||||
| FaxNumber: | 9155998579 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2009 | ||||||||
| LastUpdateDate: | 03/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223S0112X | 2732 | OH | N | Dental Providers | Dentist | Oral and Maxillofacial Surgery | 1223S0112X | 33669 | TX | Y | Dental Providers | Dentist | Oral and Maxillofacial Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1669613485 | 05 | TX | MEDICAID |