Provider Demographics
NPI:1306655758
Name:PANHANDLE ORAL & MAXILLOFACIAL SURGERY, PLLC
Entity type:Organization
Organization Name:PANHANDLE ORAL & MAXILLOFACIAL SURGERY, PLLC
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:806-398-2536
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:
Practice Address - Street 1:4905 LEXINGTON SQ
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6574
Practice Address - Country:US
Practice Address - Phone:806-367-9990
Practice Address - Fax:806-367-9945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty