Midland Mall Fdc PA

NPI #1366600504 in Midland, Texas

Provider Information

NPI Number: 1366600504
Entity Type: Organization
Organization Name: Midland Mall Fdc PA
Primary Specialty: Dentist
Enumeration Date: May 23, 2008
Last Updated: May 23, 2008

Practice Location

Address: 4511 N MIDKIFF RD
Address 2: STE E15
City: Midland
State: Texas
ZIP Code: 79705-3242
Phone: (432) 520-4867

Authorized Official

Name: LYNN ARMSTRONG
Title: REGIONAL MANAGER
Phone: (505) 328-4867

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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