NPIMap

Organization Active NPI

Texas Tech University Health Sciences Center at Amarillo

Doing business as Community Dental Clinic

  • Dental Laboratory
  • Amarillo, TX
National Provider Identifier
1023161510
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental LaboratoryTaxonomy code 292200000X
License
R26080 Issued in TX
Legal business name
TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER AT AMARILLO
Doing business as
Community Dental Clinic
Practice address
206 NE 7TH Ave
Amarillo, TX 79107-5214
Phone
(806) 374-9964
Fax
(806) 374-2945
NPI assigned
Jan 19, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Denise Russell, CPCS
Title
Credentialing Coordinator
Phone
(806) 354-5495

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Laboratory 292200000X R26080 TX Primary

Addresses

Primary practice location

206 NE 7TH Ave
Amarillo, TX 79107-5214

Mailing address

1400 Wallace Blvd
Amarillo, TX 79106-1708
Phone (806) 354-5585

Other identifiers 1

IdentifierTypeStateIssuer
R26080OtherTXX-RAY CERTIFICATION

Other names 1

  • Community Dental Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
TX Tech Univ HLTH Sci Ctr9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

206 NE 7th Ave
Amarillo, TX 79107
Phone (806) 318-3908

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1023161510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 WALLACE BLVD",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "791061708",
            "telephone_number": "806-354-5585",
            "fax_number": "806-356-4673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 NE 7TH AVE",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "791075214",
            "telephone_number": "806-374-9964",
            "fax_number": "806-374-2945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER AT AMARILLO",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "DENISE",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "806-354-5495",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CPCS"
    },
    "taxonomies": [
        {
            "code": "292200000X",
            "taxonomy_group": "",
            "desc": "Dental Laboratory",
            "state": "TX",
            "license": "R26080",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "X-RAY CERTIFICATION",
            "identifier": "R26080",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Dental Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Amarillo, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.