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General NPI Number Information
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NPI Number | 1275603946
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Entity Type | Organization
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Legal Business Name | MODERN DENTAL PROFESSIONALS ABILENE PC
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 12/22/2011
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Provider Practice Location Address
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Address Line | 3329 TURNER PLZ
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City | ABILENE
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State | TX
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Zip | 79606-8709
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Country | US
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Telephone | 325-691-1980
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Fax | 325-695-1851
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Provider Business Mailing Address
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Address Line | 6501 WINDCREST DR SUITE 100
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City | PLANO
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State | TX
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Zip | 75024-3075
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Country | US
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Telephone | 325-691-1980
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Fax | 325-695-1851
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROY D. SMITH
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Credential | DDS
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Telephone | 325-691-1980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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