Healthcare Provider Details

I. General information

NPI: 1912470774
Provider Name (Legal Business Name): ONEIDA DENTAL-AMARILLO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2019
Last Update Date: 01/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 E AMARILLO BLVD STE 300
AMARILLO TX
79107-5401
US

IV. Provider business mailing address

1261 W GREEN OAKS BLVD STE 101
ARLINGTON TX
76013-8349
US

V. Phone/Fax

Practice location:
  • Phone: 806-553-7877
  • Fax: 877-750-1323
Mailing address:
  • Phone: 817-809-4865
  • Fax: 682-626-1824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: TEE SEMERA
Title or Position: CREDENTIALING
Credential:
Phone: 817-809-4865