Provider Demographics
NPI:1134723703
Name:CHILDRENS DENTISTRY OF AMARILLO
Entity type:Organization
Organization Name:CHILDRENS DENTISTRY OF AMARILLO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:METCALF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:806-351-0008
Mailing Address - Street 1:4501 VANWINKLE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119
Mailing Address - Country:US
Mailing Address - Phone:806-351-0008
Mailing Address - Fax:806-351-0053
Practice Address - Street 1:4501 VANWINKLE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119
Practice Address - Country:US
Practice Address - Phone:806-351-0008
Practice Address - Fax:806-351-0053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty