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General NPI Number Information
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NPI Number | 1134835424
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Entity Type | Organization
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Legal Business Name | AMARILLO PEDIATRIC DENTISTRY AND ORTHODONTICS AT TOWN SQUARE PLLC
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Dates
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Enumeration Date | 01/30/2023
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Last Update Date | 01/30/2023
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Provider Practice Location Address
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Address Line | 8900 E VILLAGE SQUARE
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City | AMARILLO
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State | TX
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Zip | 79119
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Country | US
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Telephone | 806-350-5437
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Fax |
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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 | 79109-1832
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Country | US
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Telephone | 806-398-2536
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Fax |
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Authorized Official
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Title or Position | GENERAL BUSINESS DIRECTOR
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Name | LYNSEY HARRISON
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Credential |
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Telephone | 806-398-2539
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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