Organization
JAKE MODERY, D.D.S., P.C.
Active
Other names
Modery Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
JAKE MODERY D.D.S. (PRESIDENT)
(806) 731-1180
Entity
Organization
Contact information
Practice address
9200 TOWN SQUARE BLVD, SUITE 1090, AMARILLO, TX 79119-1250
(806) 731-1180
Mailing address
5902 S FANNIN ST, AMARILLO, TX 79118-8807
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
30983
TX
261QD0000X
Dental Clinic/Center
30983
TX
Other
Enumeration date
07/15/2016
Last updated
09/01/2016
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