Provider Demographics
NPI:1861649493
Name:HIGH PLAINS ORAL AND FACIAL SURGEONS
Entity Type:Organization
Organization Name:HIGH PLAINS ORAL AND FACIAL SURGEONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHESLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:806-358-7066
Mailing Address - Street 1:1900 S COULTER ST
Mailing Address - Street 2:SUITE J
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1784
Mailing Address - Country:US
Mailing Address - Phone:806-358-7066
Mailing Address - Fax:806-356-0445
Practice Address - Street 1:1900 S COULTER ST
Practice Address - Street 2:SUITE J
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1784
Practice Address - Country:US
Practice Address - Phone:806-358-7066
Practice Address - Fax:806-356-0445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-26
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD214931223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD21493Medicare PIN
TXD13315Medicare PIN