| Jake Modery, D.d.s., P.c. | |
|
9200 Town Square Blvd Suite 1090 Amarillo TX 79119-1250 | |
| (806) 731-1180 | |
| Not Available |
| Full Name | Jake Modery, D.d.s., P.c. |
|---|---|
| Speciality | Dentist |
| Location | 9200 Town Square Blvd, Amarillo, Texas |
| Authorized Official Name and Position | Jake Modery (PRESIDENT) |
| Authorized Official Contact | 8067311180 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jake Modery, D.d.s., P.c. 5902 S Fannin St Amarillo TX 79118-8807 Ph: () - | Jake Modery, D.d.s., P.c. 9200 Town Square Blvd Suite 1090 Amarillo TX 79119-1250 Ph: (806) 731-1180 |
| NPI Number | 1538512421 |
|---|---|
| Provider Enumeration Date | 07/15/2016 |
| Last Update Date | 09/01/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538512421 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 30983 (Texas) | Secondary |
| 122300000X | Dentist | 30983 (Texas) | Primary |
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