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General NPI Number Information
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NPI Number | 1760081954
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Entity Type | Individual
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Provider Name | DR. AMLAN PANKAJ
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Gender | Male
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Dates
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Enumeration Date | 10/20/2020
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Last Update Date | 10/20/2020
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Provider Practice Location Address
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Address Line | 802 E AMARILLO BLVD # 300
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City | AMARILLO
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State | TX
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Zip | 79107-5401
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Country | US
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Telephone | 806-553-7877
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Fax |
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Provider Business Mailing Address
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Address Line | 2607 WOLFLIN AVE # 901
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City | AMARILLO
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State | TX
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Zip | 79109-1825
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Country | US
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Telephone | 631-561-5464
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 36804
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License Number State | TX
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