Provider Demographics
NPI:1699915231
Name:SOUTHWEST DENTAL CARE OF ABILENE, PLLC
Entity type:Organization
Organization Name:SOUTHWEST DENTAL CARE OF ABILENE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:W
Authorized Official - Last Name:PROCTOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:325-692-2423
Mailing Address - Street 1:4601 BUFFALO GAP RD STE C4
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-3363
Mailing Address - Country:US
Mailing Address - Phone:325-692-2423
Mailing Address - Fax:325-692-2076
Practice Address - Street 1:4601 BUFFALO GAP RD STE C4
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-3363
Practice Address - Country:US
Practice Address - Phone:325-692-2423
Practice Address - Fax:325-692-2076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty