# JAKE MODERY, D.D.S., P.C.

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Modery Family Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538512421
- **Authorized official:** JAKE MODERY D.D.S. (PRESIDENT)
- **Authorized official phone:** (806) 731-1180

## Contact information

- **Practice address:** 9200 TOWN SQUARE BLVD, SUITE 1090, AMARILLO, TX 79119-1250
- **Practice address phone:** (806) 731-1180
- **Mailing address:** 5902 S FANNIN ST, AMARILLO, TX 79118-8807

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 30983 | TX | Yes |
| 261QD0000X | Dental Clinic/Center | 30983 | TX | — |

## Other

- **Enumeration date:** 07/15/2016
- **Last updated:** 09/01/2016