Organization
TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER AT AMARILLO
Active
Other names
Community Dental Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DENISE RUSSELL CPCS (CREDENTIALING COORDINATOR)
(806) 354-5495
Entity
Organization
Contact information
Practice address
206 NE 7TH AVE, AMARILLO, TX 79107-5214
(806) 374-9964
(806) 374-2945
Mailing address
1400 WALLACE BLVD, AMARILLO, TX 79106-1708
(806) 354-5585
(806) 356-4673
Taxonomy
Speciality
Code
Description
License number
State
292200000X
Dental Laboratory
Primary
R26080
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R26080
X-RAY CERTIFICATION
TX
Enumeration date
01/19/2007
Last updated
08/22/2020
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