Provider Demographics
NPI:1457699100
Name:ABBEVILLE DENTISTRY- ODESSA PLLC
Entity Type:Organization
Organization Name:ABBEVILLE DENTISTRY- 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 1:2631 FAUDREE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-8526
Mailing Address - Country:US
Mailing Address - Phone:432-301-9838
Mailing Address - Fax:432-563-1763
Practice Address - Street 1:2631 FAUDREE RD
Practice Address - Street 2:SUITE B
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79765-8526
Practice Address - Country:US
Practice Address - Phone:432-301-9838
Practice Address - Fax:432-563-1763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty