Provider Demographics
NPI:1942637731
Name:KIDS DENTISTREE OF ABBEVILLE-ODESSA PLLC
Entity Type:Organization
Organization Name:KIDS DENTISTREE OF ABBEVILLE-ODESSA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KATHIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-254-8501
Mailing Address - Street 1:621 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4509
Mailing Address - Country:US
Mailing Address - Phone:432-580-7220
Mailing Address - Fax:
Practice Address - Street 1:621 E 7TH ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4509
Practice Address - Country:US
Practice Address - Phone:432-580-7220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-11
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty