Provider Demographics
NPI:1699288423
Name:YELLOW HOUSE DENTAL & IMPLANT CENTER, PLLC
Entity type:Organization
Organization Name:YELLOW HOUSE DENTAL & IMPLANT CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:LAUREN
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-797-0341
Mailing Address - Street 1:2420 QUAKER AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1837
Mailing Address - Country:US
Mailing Address - Phone:806-797-0341
Mailing Address - Fax:806-797-1607
Practice Address - Street 1:2420 QUAKER AVE STE 104
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1837
Practice Address - Country:US
Practice Address - Phone:806-797-0341
Practice Address - Fax:806-797-1607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty