Midland Park Mall Dental Practice, P.c.

NPI #1467757112 in Midland, Texas

Provider Information

NPI Number: 1467757112
Entity Type: Organization
Organization Name: Midland Park Mall Dental Practice, P.c.
Primary Specialty: Dentist - General Practice
Enumeration Date: Jan 11, 2011
Last Updated: Jan 11, 2011

Practice Location

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

Authorized Official

Name: JENNIFER OWENS
Title: MANAGER
Phone: (432) 520-4867

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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