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Contact Information

SPECIAL NEEDS DENTISTRY
2420 QUAKER AVE
SUITE 101
LUBBOCK, TX79410-1817
 Phone: 806-701-5066
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dental Public Health

1223D0001X
Indicates primary specialty

NPI Profile & details for SPECIAL NEEDS DENTISTRY

NPI Number 1023408192
LBN Legal business name SPECIAL NEEDS DENTISTRY
Authorized official RUSSELL REDDELL - (OWNER/MANAGER)
Entity Organization
Organization subpart 1 No
Enumeration date 01/28/2015
Last updated 01/28/2015 - About 11 years ago
Identifiers
TX License # 19405
TX Medicaid 180035102
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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