Provider Demographics
NPI:1851941207
Name:CLARENDON DENTAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:CLARENDON DENTAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:VLOSICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:806-584-4074
Mailing Address - Street 1:4603 CHESAPEAKE PLACE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119
Mailing Address - Country:US
Mailing Address - Phone:806-584-4074
Mailing Address - Fax:
Practice Address - Street 1:# 5 MEDICAL DRIVE
Practice Address - Street 2:
Practice Address - City:CLARENDON
Practice Address - State:TX
Practice Address - Zip Code:79226
Practice Address - Country:US
Practice Address - Phone:806-584-4074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty