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General NPI Number Information
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NPI Number | 1851941207
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Entity Type | Organization
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Legal Business Name | CLARENDON DENTAL ASSOCIATES PLLC
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Dates
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Enumeration Date | 09/18/2019
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Last Update Date | 09/18/2019
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Provider Practice Location Address
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Address Line | # 5 MEDICAL DRIVE
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City | CLARENDON
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State | TX
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Zip | 79226
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Country | US
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Telephone | 806-584-4074
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Fax |
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Provider Business Mailing Address
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Address Line | 4603 CHESAPEAKE PLACE
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City | AMARILLO
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State | TX
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Zip | 79119
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Country | US
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Telephone | 806-584-4074
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | EDWARD JOHN VLOSICH
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Credential | DDS
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Telephone | 806-584-4074
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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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