Provider Demographics
NPI:1316083462
Name:CHILDREN'S DENTISTRY OF ABILENE
Entity type:Organization
Organization Name:CHILDREN'S DENTISTRY OF ABILENE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NORM
Authorized Official - Middle Name:P
Authorized Official - Last Name:POORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PA
Authorized Official - Phone:325-692-9557
Mailing Address - Street 1:2501 S WILLIS ST
Mailing Address - Street 2:STE C
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-6287
Mailing Address - Country:US
Mailing Address - Phone:325-692-9557
Mailing Address - Fax:325-692-8316
Practice Address - Street 1:2501 S WILLIS ST STE C
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-6249
Practice Address - Country:US
Practice Address - Phone:325-692-9557
Practice Address - Fax:325-692-8316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty