Provider Demographics
NPI:1396055588
Name:AMARILLO FAMILY DENTISTRY, PA
Entity type:Organization
Organization Name:AMARILLO FAMILY DENTISTRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:ALTON
Authorized Official - Last Name:BARRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:806-372-3076
Mailing Address - Street 1:3330 EAST INTERSTATE 40
Mailing Address - Street 2:UNIT J
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79103-4801
Mailing Address - Country:US
Mailing Address - Phone:806-372-3076
Mailing Address - Fax:806-372-6504
Practice Address - Street 1:3330 EAST INTERSTATE 40
Practice Address - Street 2:UNIT J
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79103-4801
Practice Address - Country:US
Practice Address - Phone:806-372-3076
Practice Address - Fax:806-372-6504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty