=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942637574
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JON K. ORMSON, DDS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2013
-----------------------------------------------------
Last Update Date | 09/27/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4600 W I 40 STE 201
-----------------------------------------------------
City | AMARILLO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79106-5836
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-354-8526
-----------------------------------------------------
Fax | 806-353-0089
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7628 CATSKILL AVE
-----------------------------------------------------
City | AMARILLO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79121-1919
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-882-2568
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | JON ORMSON
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 713-882-2568
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------