Healthcare Provider Details

I. General information

NPI: 1306655758
Provider Name (Legal Business Name): PANHANDLE ORAL & MAXILLOFACIAL SURGERY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2024
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4905 LEXINGTON SQ
AMARILLO TX
79119-6574
US

IV. Provider business mailing address

2300 WOLFLIN AVE
AMARILLO TX
79109-1832
US

V. Phone/Fax

Practice location:
  • Phone: 806-367-9990
  • Fax: 806-367-9945
Mailing address:
  • Phone: 806-350-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: LYNSEY HARRISON
Title or Position: COO
Credential:
Phone: 806-398-2536