Healthcare Provider Details

I. General information

NPI: 1689426397
Provider Name (Legal Business Name): LUBBOCK DENTAL SPECIALISTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2024
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 W 24TH ST
PLAINVIEW TX
79072-1855
US

IV. Provider business mailing address

2201 CIVIC CIR STE 600
AMARILLO TX
79109-1817
US

V. Phone/Fax

Practice location:
  • Phone: 806-412-0000
  • Fax: 806-353-7077
Mailing address:
  • Phone: 806-353-1055
  • Fax: 806-353-7077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER LYNN MORRIS
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 806-353-1055