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Organization
PERMIAN BASIN DENTAL GROUP
Active
Organization
PERMIAN BASIN DENTAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH WELBY HIGGINS D.D.S. (OWNER)
(432) 563-1760
Entity
Organization
Contact information
Practice address
2631 FAUDREE RD UNIT B, ODESSA, TX 79765-8530
(432) 563-1760
(432) 563-1763
Mailing address
2631 FAUDREE RD UNIT B, ODESSA, TX 79765-8530
(432) 563-1760
(432) 563-1763
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12663
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
177458001
—
TX
Enumeration date
04/03/2007
Last updated
08/08/2012
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