| South Plains Pediatric Dental Group | |
|
5102 Salem Ave Lubbock TX 79414-4036 | |
| (806) 795-9503 | |
| Not Available |
| Full Name | South Plains Pediatric Dental Group |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 5102 Salem Ave, Lubbock, Texas |
| Authorized Official Name and Position | Dietmar Kennel (OWNER/PARTNER) |
| Authorized Official Contact | 8067959503 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Plains Pediatric Dental Group 5102 Salem Ave Lubbock TX 79414-4036 Ph: (806) 795-9503 | South Plains Pediatric Dental Group 5102 Salem Ave Lubbock TX 79414-4036 Ph: (806) 795-9503 |
| NPI Number | 1154504918 |
|---|---|
| Provider Enumeration Date | 12/14/2007 |
| Last Update Date | 12/14/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154504918 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 19264 (Texas) | Primary |
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