Provider Demographics
NPI:1104578178
Name:B.G. SINCLAIR, DDS, P.A.
Entity type:Organization
Organization Name:B.G. SINCLAIR, DDS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:SINCLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:877-297-6743
Mailing Address - Street 1:2207 S WESTERN ST STE 40
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-1542
Mailing Address - Country:US
Mailing Address - Phone:877-297-6743
Mailing Address - Fax:
Practice Address - Street 1:2207 S WESTERN ST STE 40
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-1542
Practice Address - Country:US
Practice Address - Phone:877-297-6743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty