Provider Demographics
NPI:1255840351
Name:ABILENE ENDODONTICS, PC
Entity Type:Organization
Organization Name:ABILENE ENDODONTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:R
Authorized Official - Last Name:SOUTHARD
Authorized Official - Suffix:
Authorized Official - Credentials:FACHE, FHFMA, CMPE
Authorized Official - Phone:325-704-5001
Mailing Address - Street 1:5849 BUFFALO GAP ROAD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606
Mailing Address - Country:US
Mailing Address - Phone:325-704-5001
Mailing Address - Fax:325-704-5141
Practice Address - Street 1:5849 BUFFALO GAP ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606
Practice Address - Country:US
Practice Address - Phone:325-704-5001
Practice Address - Fax:325-704-5141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty