Provider Demographics
NPI:1851309280
Name:ARCHER, JOHN MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:ARCHER
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 1:1900 COULTER ROAD
Mailing Address - Street 2:SUITE G
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79107-1732
Mailing Address - Country:US
Mailing Address - Phone:806-355-7249
Mailing Address - Fax:806-355-3966
Practice Address - Street 1:1900 COULTER ROAD
Practice Address - Street 2:SUITE G
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79107-1732
Practice Address - Country:US
Practice Address - Phone:806-355-7249
Practice Address - Fax:806-355-3966
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice