# AMARILLO DENTAL ASSOCIATES

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Michael D Vaclav DDS & Ryan Street DDS
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356517650
- **Authorized official:** MICHAEL D VACLAV DDS (PARTNER)
- **Authorized official phone:** (806) 355-7463

## Contact information

- **Practice address:** 4525 VAN WINKLE, AMARILLO, TX 79119
- **Practice address phone:** (806) 355-7463
- **Practice address fax:** (806) 355-6014
- **Mailing address:** 4525 VAN WINKLE, AMARILLO, TX 79119
- **Mailing address phone:** (806) 355-7463
- **Mailing address fax:** (806) 355-6014

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 10364 | TX | Yes |
| 122300000X | Dentist | 21834 | TX | — |
| 1223G0001X | General Practice Dentistry | 21834 | TX | — |

## Other

- **Enumeration date:** 05/06/2008
- **Last updated:** 05/26/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0095226-01 | — | TX |
| 01 | — | 1578606901 | RYAN STREET DDS | TX |
| 01 | — | 1710020177 | MICHAEL VACLAV DDS | TX |