Provider Demographics
NPI:1063993020
Name:AMARILLO PEDIATRIC DENTISTRY AND ORTHODONTICS, PA
Entity type:Organization
Organization Name:AMARILLO PEDIATRIC DENTISTRY AND ORTHODONTICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:LYNSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-350-5437
Mailing Address - Street 1:2300 WOLFLIN AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-1832
Mailing Address - Country:US
Mailing Address - Phone:806-350-5437
Mailing Address - Fax:806-350-5438
Practice Address - Street 1:74 PATTERSON CIRCLE
Practice Address - Street 2:
Practice Address - City:BOYS RANCH
Practice Address - State:TX
Practice Address - Zip Code:79010
Practice Address - Country:US
Practice Address - Phone:806-350-5437
Practice Address - Fax:806-350-5438
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMARILLO PEDIATRIC DENTISTRY AND ORTHODONTICS PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-27
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty