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General NPI Number Information
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NPI Number | 1699260497
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Entity Type | Organization
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Legal Business Name | ABILENE DENTAL CARE SOUTH PLLC
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Dates
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Enumeration Date | 06/25/2018
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Last Update Date | 09/12/2019
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Provider Practice Location Address
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Address Line | 4102 BUFFALO GAP RD STE F
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City | ABILENE
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State | TX
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Zip | 79605-7243
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Country | US
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Telephone | 325-200-4820
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Fax |
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Provider Business Mailing Address
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Address Line | 4102 BUFFALO GAP RD STE F
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City | ABILENE
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State | TX
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Zip | 79605-7243
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Country | US
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Telephone | 325-200-4820
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Fax | 972-590-8809
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Authorized Official
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Title or Position | DIRECTOR OF CREDENTIALING
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Name | FAITH GASKINS
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Credential |
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Telephone | 630-877-3520
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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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