| Special Needs Dentistry | |
|
2420 Quaker Ave Suite 101 Lubbock TX 79410-1817 | |
| (806) 701-5066 | |
| Not Available |
| Full Name | Special Needs Dentistry |
|---|---|
| Speciality | Dentist - Dental Public Health |
| Location | 2420 Quaker Ave, Lubbock, Texas |
| Authorized Official Name and Position | Russell Wayne Reddell (OWNER/MANAGER) |
| Authorized Official Contact | 8067015066 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Special Needs Dentistry 16304 County Road 2040 Lubbock TX 79423-4618 Ph: (806) 368-2005 | Special Needs Dentistry 2420 Quaker Ave Suite 101 Lubbock TX 79410-1817 Ph: (806) 701-5066 |
| NPI Number | 1023408192 |
|---|---|
| Provider Enumeration Date | 01/28/2015 |
| Last Update Date | 01/28/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023408192 | NPI | - | NPPES |
| 180035102 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223D0001X | Dentist - Dental Public Health | 19405 (Texas) | Primary |
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