Provider Demographics
NPI:1558784140
Name:LUBBOCK ENDODONTICS, PC
Entity Type:Organization
Organization Name:LUBBOCK ENDODONTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHADWICK
Authorized Official - Middle Name:M
Authorized Official - Last Name:SARGENT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:806-797-4455
Mailing Address - Street 1:7515 QUAKER AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-5308
Mailing Address - Country:US
Mailing Address - Phone:806-797-4455
Mailing Address - Fax:
Practice Address - Street 1:7515 QUAKER AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-5308
Practice Address - Country:US
Practice Address - Phone:806-797-4455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty