Healthcare Provider Details

I. General information

NPI: 1003511106
Provider Name (Legal Business Name): MATTHEW HUANG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 07/08/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3113 ROSS ST
AMARILLO TX
79103-2700
US

IV. Provider business mailing address

3113 ROSS ST
AMARILLO TX
79103-2700
US

V. Phone/Fax

Practice location:
  • Phone: 806-374-7341
  • Fax:
Mailing address:
  • Phone: 806-374-7341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number40669
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: