1023422367 NPI number — WEST TEXAS ENDODONTICS, PC

Table of content: (NPI 1023422367)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023422367 NPI number — WEST TEXAS ENDODONTICS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST TEXAS ENDODONTICS, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023422367
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7515 QUAKER AVE
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
LUBBOCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79424-5308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-797-4455
Provider Business Mailing Address Fax Number:
806-797-2460

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6112 N STATE HIGHWAY 349
Provider Second Line Business Practice Location Address:
SUITE A1
Provider Business Practice Location Address City Name:
MIDLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79705-2010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-797-4455
Provider Business Practice Location Address Fax Number:
806-797-2460
Provider Enumeration Date:
06/15/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SARGENT
Authorized Official First Name:
CHADWICK
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
806-797-4455

Provider Taxonomy Codes

  • Taxonomy code: 1223E0200X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)