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General NPI Number Information
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NPI Number | 1316083462
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Entity Type | Organization
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Legal Business Name | CHILDREN'S DENTISTRY OF ABILENE
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 06/12/2008
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Provider Practice Location Address
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Address Line | 2501 S WILLIS ST STE C
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City | ABILENE
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State | TX
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Zip | 79605-6249
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Country | US
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Telephone | 325-692-9557
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Fax | 325-692-8316
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Provider Business Mailing Address
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Address Line | 2501 S WILLIS ST STE C
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City | ABILENE
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State | TX
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Zip | 79605-6287
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Country | US
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Telephone | 325-692-9557
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Fax | 325-692-8316
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Authorized Official
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Title or Position | DENTIST
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Name | DR. NORM P POORMAN
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Credential | DDS, PA
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Telephone | 325-692-9557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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