Provider Demographics
NPI:1629643523
Name:SHORT, PAXTON GENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAXTON
Middle Name:GENE
Last Name:SHORT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7505 TRIPP AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79121-1845
Mailing Address - Country:US
Mailing Address - Phone:806-206-2994
Mailing Address - Fax:
Practice Address - Street 1:3503 S SONCY RD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6401
Practice Address - Country:US
Practice Address - Phone:806-374-8011
Practice Address - Fax:806-356-0281
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37305122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist