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General NPI Number Information
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NPI Number | 1508403254
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Entity Type | Organization
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Legal Business Name | LUBBOCK PEDIATRIC DENTISTRY PLLC
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Dates
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Enumeration Date | 12/02/2019
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 6309 4TH ST STE 100
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City | LUBBOCK
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State | TX
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Zip | 79416-4281
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Country | US
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Telephone | 806-318-5241
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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 | 806-350-5437
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LYNSEY HARRISON
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Credential |
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Telephone | 806-350-5437
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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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