Provider Demographics
NPI:1982988614
Name:HOUSTON, VLOSICH & SHORT DDS INC.
Entity Type:Organization
Organization Name:HOUSTON, VLOSICH & SHORT DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:806-374-8011
Mailing Address - Street 1:3503 S SONCY RD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-6401
Mailing Address - Country:US
Mailing Address - Phone:806-374-8011
Mailing Address - Fax:806-356-0281
Practice Address - Street 1:3503 S SONCY RD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6401
Practice Address - Country:US
Practice Address - Phone:806-374-8011
Practice Address - Fax:806-356-0281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-29
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX193511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty