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General NPI Number Information
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NPI Number | 1366882524
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Entity Type | Organization
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Legal Business Name | ABBEVILLE DENTISTRY - AMARILLO, PLLC
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Dates
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Enumeration Date | 07/02/2013
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Last Update Date | 07/02/2013
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Provider Practice Location Address
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Address Line | 3630 SW 45TH AVE
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City | AMARILLO
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State | TX
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Zip | 79109-5689
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Country | US
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Telephone | 806-223-2886
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Fax | 502-245-5021
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Provider Business Mailing Address
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Address Line | 3630 SW 45TH AVE
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City | AMARILLO
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State | TX
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Zip | 79109-5689
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Country | US
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Telephone | 806-223-2886
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Fax | 502-245-5021
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | JANELLE PICKLESIMER
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Credential |
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Telephone | 502-254-8500
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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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