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General NPI Number Information
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NPI Number | 1396055588
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Entity Type | Organization
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Legal Business Name | AMARILLO FAMILY DENTISTRY, PA
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Dates
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Enumeration Date | 10/21/2010
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Last Update Date | 10/21/2010
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Provider Practice Location Address
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Address Line | 3330 EAST INTERSTATE 40 UNIT J
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City | AMARILLO
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State | TX
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Zip | 79103-4801
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Country | US
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Telephone | 806-372-3076
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Fax | 806-372-6504
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Provider Business Mailing Address
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Address Line | 3330 EAST INTERSTATE 40 UNIT J
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City | AMARILLO
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State | TX
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Zip | 79103-4801
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Country | US
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Telephone | 806-372-3076
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Fax | 806-372-6504
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | LARRY ALTON BARRY
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Credential | DDS
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Telephone | 806-372-3076
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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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