Individual
JAKE MODERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
9200 TOWN SQUARE BLVD, SUITE 1090, AMARILLO, TX 79119-1250
(806) 731-1180
(806) 414-4680
Mailing address
5902 S FANNIN ST, AMARILLO, TX 79118-8807
(806) 731-1180
(806) 414-4680
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
30983
TX
Other
Enumeration date
06/13/2015
Last updated
09/01/2016
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