Healthcare Provider Details

I. General information

NPI: 1497973598
Provider Name (Legal Business Name): CLINTON LEE ESLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 09/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6834 PLUM CREEK DR
AMARILLO TX
79124-1601
US

IV. Provider business mailing address

6834 PLUM CREEK DR
AMARILLO TX
79124-1601
US

V. Phone/Fax

Practice location:
  • Phone: 806-358-8021
  • Fax:
Mailing address:
  • Phone: 806-358-8021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11745
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: