Provider Demographics
NPI:1366882524
Name:ABBEVILLE DENTISTRY - AMARILLO, PLLC
Entity type:Organization
Organization Name:ABBEVILLE DENTISTRY - AMARILLO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKLESIMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-254-8500
Mailing Address - Street 1:3630 SW 45TH AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-5689
Mailing Address - Country:US
Mailing Address - Phone:806-223-2886
Mailing Address - Fax:502-245-5021
Practice Address - Street 1:3630 SW 45TH AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-5689
Practice Address - Country:US
Practice Address - Phone:806-223-2886
Practice Address - Fax:502-245-5021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty