Provider Demographics
NPI:1558743872
Name:LUBBOCK DENTAL IMPLANT CENTER PLLC
Entity Type:Organization
Organization Name:LUBBOCK DENTAL IMPLANT CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-797-1275
Mailing Address - Street 1:4415 66TH ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79414-4809
Mailing Address - Country:US
Mailing Address - Phone:806-797-1275
Mailing Address - Fax:806-797-1274
Practice Address - Street 1:4415 66TH ST
Practice Address - Street 2:SUITE 112
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79414-4809
Practice Address - Country:US
Practice Address - Phone:806-797-1275
Practice Address - Fax:806-797-1274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23079122300000X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty