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1401 E 8th St Odessa TX 79761-4802 | |
| (432) 332-8550 | |
| (432) 332-8560 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1401 E 8th St, Odessa, Texas |
| Authorized Official Name and Position | Brandon Alexander Taylor (CREDENTIALING PAYER RELATIONS MGR) |
| Authorized Official Contact | 8474537396 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2050 East Algonquin Road Suite 610 Schaumburg IL 60173-4166 Ph: (847) 453-7396 | 1401 E 8th St Odessa TX 79761-4802 Ph: (432) 332-8550 |
| NPI Number | 1861712093 |
|---|---|
| Provider Enumeration Date | 06/10/2010 |
| Last Update Date | 10/15/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861712093 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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