| Amarillo Pediatric Dentistry | |
|
2455 W Interstate 40 Amarillo TX 79109-1852 | |
| (806) 350-5437 | |
| (806) 350-5438 |
| Full Name | Amarillo Pediatric Dentistry |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 2455 W Interstate 40, Amarillo, Texas |
| Authorized Official Name and Position | Shane L Moore (OWNER) |
| Authorized Official Contact | 8063505437 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Amarillo Pediatric Dentistry 2455 W Interstate 40 Amarillo TX 79109-1852 Ph: (806) 350-5437 | Amarillo Pediatric Dentistry 2455 W Interstate 40 Amarillo TX 79109-1852 Ph: (806) 350-5437 |
| NPI Number | 1073614772 |
|---|---|
| Provider Enumeration Date | 09/26/2006 |
| Last Update Date | 05/01/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073614772 | NPI | - | NPPES |
| 0042NQ | Other | TX | BLUE CROSS BLUE SHIELD |
| 177133901 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 18661 (Texas) | Primary |
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