| Odessa Mall Fdc Pa | |
|
4101 E 42nd Ste B23 Odessa TX 79762-7239 | |
| (432) 363-4867 | |
| (432) 363-1799 |
| Full Name | Odessa Mall Fdc Pa |
|---|---|
| Speciality | Dentist |
| Location | 4101 E 42nd, Odessa, Texas |
| Authorized Official Name and Position | Lynn Armstrong (REGIONAL MANAGER) |
| Authorized Official Contact | 5053284867 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Odessa Mall Fdc Pa 4101 E 42nd Ste B23 Odessa TX 79762-7239 Ph: (432) 363-4867 | Odessa Mall Fdc Pa 4101 E 42nd Ste B23 Odessa TX 79762-7239 Ph: (432) 363-4867 |
| NPI Number | 1801054044 |
|---|---|
| Provider Enumeration Date | 05/23/2008 |
| Last Update Date | 05/23/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801054044 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 0008481 (Texas) | Primary |
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