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General NPI Number Information
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NPI Number | 1073614772
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Entity Type | Organization
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Legal Business Name | AMARILLO PEDIATRIC DENTISTRY AND ORTHODONTICS, PLLC
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 02/20/2025
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Provider Practice Location Address
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Address Line | 2300 WOLFLIN AVE
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City | AMARILLO
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State | TX
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Zip | 79109
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Country | US
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Telephone | 806-398-2536
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Fax | 806-350-5438
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Provider Business Mailing Address
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Address Line | 2300 WOLFLIN AVE
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City | AMARILLO
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State | TX
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Zip | 79109
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Country | US
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Telephone | 806-350-5437
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Fax | 806-350-5438
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Authorized Official
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Title or Position | COO
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Name | LYNSEY HARRISON
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Credential |
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Telephone | 806-350-5437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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