| Permian Basin Dental Group | |
|
2631 Faudree Rd Unit B Odessa TX 79765-8530 | |
| (432) 563-1760 | |
| (432) 563-1763 |
| Full Name | Permian Basin Dental Group |
|---|---|
| Speciality | Dentist |
| Location | 2631 Faudree Rd Unit B, Odessa, Texas |
| Authorized Official Name and Position | Kenneth Welby Higgins (OWNER) |
| Authorized Official Contact | 4325631760 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Permian Basin Dental Group 2631 Faudree Rd Unit B Odessa TX 79765-8530 Ph: (432) 563-1760 | Permian Basin Dental Group 2631 Faudree Rd Unit B Odessa TX 79765-8530 Ph: (432) 563-1760 |
| NPI Number | 1972625978 |
|---|---|
| Provider Enumeration Date | 04/03/2007 |
| Last Update Date | 08/08/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972625978 | NPI | - | NPPES |
| 177458001 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 12663 (Texas) | Primary |
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